Late stent thrombosis with drug-eluting stents: the price to pay to prevent restenosis?

ABSTRACT

Drug-eluting stents have revolutionized the management of patients with coronary artery disease by decreasing the incidence of restenosis and the need for repeat revascularization. Recent data indicate that they may, however, be associated with a small but significant increase in the risk of late stent thrombosis compared with bare-metal stents. In this review, we discuss the incidence, pathogenesis, and predictors of stent thrombosis, the most important being premature cessation of dual antiplatelet therapy. Drug-eluting stent implantation needs to be carefully considered in every patient, and the risk of stent thrombosis and bleeding needs to be weighed against the risk of restenosis. Current guidelines recommend that dual antiplatelet therapy should be continued for at least 1 year following drug-eluting stent implantation, although the optimal duration of therapy is yet unknown.