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High-Sensitivity Troponin and The Application of Risk Stratification Thresholds in Patients with Suspected Acute Coronary Syndrome New technologies for intensive prevention programs after myocardial infarction: rationale and design of the NET-IPP trial Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction - The Randomized SHOCK-COOL Trial Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study Clarification of Myocardial Infarction Types Decreased inspired oxygen stimulates de novo formation of coronary collaterals in adult heart Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial The prognostic role of mid-range ejection fraction in ST-segment elevation myocardial infarction Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association
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Review ArticleVolume 71, Issue 15, April 2018

JOURNAL：J Am Coll Cardiol. Article Link

Restenosis, Stent Thrombosis, and Bleeding Complications - Navigating Between Scylla and Charybdis

J Torrado, L Buckley, A Durán et al. Keywords: biodegradable polymers; bioresorbable vascular scaffold; bleeding; drug-eluting stent; PCI; stent restenosis; stent thrombosis

ABSTRACT

The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure. In the present era of interventional cardiology, the tradeoff between stent thrombosis, restenosis, and bleeding presents as a particularly complex challenge. In this review, the authors highlight major contributors of late/very late stent thrombosis while targeting stent restenosis, and they discuss evolutionary advances in stent technology and antiplatelet therapy, to further improve upon the care of patients with coronary artery disease.

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