Author + information
- Received October 15, 2017
- Revision received January 17, 2018
- Accepted February 11, 2018
- Published online April 9, 2018.
- Juan Torrado, MD, PhDa,b,
- Leo Buckley, PharmDa,
- Ariel Durán, MDb,
- Pedro Trujillo, MDb,
- Stefano Toldo, PhDa,
- Juan Valle Raleigh, MDc,
- Antonio Abbate, MD, PhDa,d,
- Giuseppe Biondi-Zoccai, MD, MState,f and
- Luis A. Guzmán, MDa,∗ ()
- aDepartment of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
- bDepartment of Cardiology, Clinic Hospital, School of Medicine, Republic University, Montevideo, Uruguay
- cDepartment of Cardiology, Hospital Italiano, Buenos Aires, Argentina
- dVictoria Johnson Research Laboratory, Virginia Commonwealth University, Richmond, Virginia
- eDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- fDepartment of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
- ↵∗Address for correspondence:
Dr. Luis A. Guzmán, Department of Cardiology, Virginia Commonwealth University, 1200 East Broad Street, 5th Floor, West Wing, Room #526, Richmond, Virginia 23298.
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.
- biodegradable polymers
- bioresorbable vascular scaffold
- drug-eluting stent
- percutaneous coronary intervention
- stent restenosis
- stent thrombosis
Prof. Biondi-Zoccai has consulted for Abbott Vascular and Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 15, 2017.
- Revision received January 17, 2018.
- Accepted February 11, 2018.
- 2018 American College of Cardiology Foundation
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