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Miodrag R. Damjanović
Clinic of Cardiovascular Diseases
Clinical Center Niš,
Bulevar Dr Zorana Đinđića 48
18000 Niš, Serbia
CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH STENT THROMBOSIS
Miodrag Damjanović1, Milan Pavlović1,2, Svetlana Apostolović1,2, Zoran Perišić1,2, Sonja Šalinger-Martinović1,2, Milan Živković1, Nenad Božinović1, Vladimir Miloradović3,4, Danijela Đorđević-Radojković1, Boris Đinđić1,2, Goran Koraćević1,2, Miloje Tomašević4, Goran Davidović3,4, Vera Irić-Ćupić4
Clinic of Cardiovascular Diseases, Clinical Center Niš, Niš, Serbia1
University of Niš, Faculty of Medicine in Niš, Niš, Serbia2
Clinic of Cardiology, Clinical Center of Kragujevac, Faculty of Medical Sciences Kragujevac, Serbiac3
Stent thrombosis (TS) after percutaneous coronary intervention (PCI) is a rare but potentially fatal complication with an incidence of 1% to over 5%. Risk factors for TS can be divided into factors related to the patient, procedure, stent type and characteristics of the lesion.
One thousand fifty-five patients who underwent PCI during 2009 and 2010 were included into the study and followed during the next year. Patients with and without definite TS formed the study (TS+) and control group (TS+), respectively.
Twenty-three patients had TS (2,2%). Early, late and very late TS were noted in 69,5%, 13,1% and 17,4% of patients, respectively. Acute myocardial infarction with ST-segment elevation was the most frequent clinical presentation (56,6%). Discontinuation of aspirin and/or clopidogrel (34.8%) and resistance to these drugs (34.7%) were the main patient-related factors for TS. A higher percentage of stenosis of lesions (92 ± 12 vs 86 ± 14), greater average stent length (19.69 vs 17.01 mm), lower pressure stent insufflation (14.84 vs. 16.02 atm) and coronary artery dissection (26.1%) were significant reasons for the occurrence of TS. Similar stent type - BMS („bare metal stents) and DES („drug eluting stents“) were applied in both of patient groups.
STEMI patients and those with impaired systolic left ventricular function are at highest risk of TS, which is reported in more than two thirds of them in the first 30 days after PCI. Discontinuation of aspirin and/or clopidogral or resistance to these drugs led to TS. Greater stent length, small diameter of the stent ("underestimated lesion"), lower pressure insufflation and dissection of the coronary artery are the most common procedural reasons for the occurrence of TS. Type of stent (BMS and DES) had no significant effect on the occurrence of TS. Acta Medica Medianae 2013;52(4):5-11.
Key words: percutaneous coronary intervention, stent thrombosis