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Posts Tagged ‘acute stent thrombosis’

Which is the “Numero uno”  cause  for  acute stent thrombosis  in real world  Cath labs ?

  1. Hypersensitivity  reaction  to metals
  2. Poor deployment of stent
  3. Inadequate  Anti-platelet  regimen
  4. Drug eluting stent

Answer :  2 .(Indisputably  correct )

It is estimated  at-least 4 out of 10 stents  we implant  is  sub-optimally  deployed .Only a fraction of them go for complication .Coronary endothelium silently  tolerates our  aggression .

How to  prevent this ?

  • Meticulous pre procedure analysis of lesion
  • Preparing the lesion if toughness is anticipated
  • Personal  mind application in stent size  selection
  • A slow , steady  non aggressive PCI
  • Liberal  pre and post dilatations
  • Judious use of IVUS and OCT ( Mind  you a  prolonged  IVUS procedure  can occasionally convert a good deployment into bad one !)
  • A  good quality anti-platelet regimen.

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Radiation injury to coronary artery  is rarely given a thought , in spite of   prolonged fluro-scopic time  during  many complex angioplasties.While the cardiologists are fully protected the patient’s heart takes on the brunt of the attack.

What happens to the coronary endothelium -metal interface when X -rays pass through it ?

It is well known the radiation delivered to a tissue is many times  amplified if a metal interface is present. Further , the metals can produce heat on exposure to radiation . This absorption and heat varies with different metals .

The radiation injury to coronary endothelium  could be  significantly higher with DES , as the polymer in it absorbs more radiation than the bare metal stent. This could be responsible for late complications of DES.

The above  concept (unproven though !) is  proposed  by  http://circ.ahajournals.org/cgi/content/full/104/5/e23 .In this study Gold coated coronary stents were found to be less safe than conventional stent

It may take many years to know the truths  about  radiation injury caused by  of coronary stents  .

But always remember , unproven concepts are  not synonymous with wrong concepts !

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