Thrombosis and Antiplatelet Therapy

Abstract

The use of DES has substantially reduced restenosis and expanded the frontiers of coronary angioplasty, allowing the effective treatment of increasingly complex lesions, which were previously considered to require surgery. However, the use of DES has recently been at the center of various controversies relating to an associated potential increase in thrombosis owing to delayed DES endothelialization. Thrombosis is an extremely relevant phenomenon when dealing with a vessel of critical importance like the LMCA, as the consequences of a thrombotic event can prove to be catastrophic. Various reports of patients with LMCA disease treated with DES have shown that thrombosis occurs with a very low frequency. Studies on LMCA PCI with DES have reported a total incidence of definite and probable thrombosis (including early, late, and very late thrombosis), as defined by the Academic Research Consortium (ARC), of no more than 1% [52, 64, 65]. In particular, very late definite thrombosis is seldom observed, with a reported frequency ranging between 0% and 0.3% [52, 64, 65]. A more recent study specifically assessed the incidence of thrombosis according to ARC definitions in 731 patients affected by LMCA stenosis treated with SES or PES in five centers [164]. Definite or probable thrombosis was observed in 0.95% of the study population at 2.5 years. All these thrombotic events affected the LMCA bifurcation, which, in the majority of cases, was treated with the two-stent technique. No cases of very late definite thrombosis were observed.