Stenttromboser

Stenttromboser, or stent thrombosis, is the formation of a blood clot inside a deployed vascular stent, most commonly in a coronary artery after percutaneous coronary intervention (PCI). The clot can acutely occlude the treated vessel, leading to chest pain and myocardial infarction and, in severe cases, death. Although rare, it is a feared complication because it can cause sudden loss of blood flow to heart tissue.

Stent thrombosis is typically described by timing after stent implantation. Acute stent thrombosis occurs within 24 hours, subacute within 24 hours to 30 days, late between 30 days and one year, and very late after more than one year. Definitions used in research distinguish definite, probable, and possible stent thrombosis based on clinical and angiographic criteria. Drug-eluting stents and other advances have reduced overall risk, but the event remains influenced by factors such as adherence to dual antiplatelet therapy (DAPT), stent expansion and apposition, outlet lesions, and patient factors.

Risk factors include premature discontinuation of DAPT, insufficient antiplatelet effect, high platelet reactivity, diabetes, complex or bifurcation lesions, stent underexpansion or malapposition, and procedural issues during implantation. Stenttromboser can occur with either bare-metal or drug-eluting stents, though patterns and timing may differ between stent types. In addition to PCI-related factors, systemic conditions like infection or inflammatory states may contribute.

Diagnosis relies on clinical presentation supported by coronary angiography, which shows impaired blood flow or a filling defect within the stent. Imaging modalities such as intravascular ultrasound or optical coherence tomography can help identify mechanical causes. Management requires rapid reperfusion, usually by repeat PCI with optimized stent deployment and antithrombotic therapy, alongside reinforcement of antiplatelet regimens to prevent recurrence. Prevention centers on meticulous implantation technique, appropriate stent choice, and strict adherence to prescribed DAPT when indicated.