๐๐ญ๐๐ง๐ญ ๐๐ก๐ซ๐จ๐ฆ๐๐จ๐ฌ๐ข๐ฌ
#CCU_CORONARY
Stent Thrombosis, although rare (occur in <1%
patients within the first year), is one of the most
serious complications following stent placement.
More than 80% of patients who experience
stent thrombosis present with acute MI, and
30-day mortality rates in patients with stent
thrombosis range from 10% to 25%.
As a result, prevention and treatment of
this complication are of utmost importance.
โโโโโโโโโโโโโโโโโโโโโโโโ-
๐๐๐ ๐ข๐ค๐จ๐ฉ ๐ฌ๐๐๐๐ก๐ฎ ๐ช๐จ๐๐ ๐๐๐๐๐ฃ๐๐ฉ๐๐ค๐ฃ ๐๐ฃ๐ซ๐ค๐ก๐ซ๐๐ฃ๐ ๐ฉ๐๐ ๐๐ก๐๐จ๐จ๐๐๐๐๐๐ฉ๐๐ค๐ฃ ๐๐ฃ๐ ๐ฉ๐๐ข๐๐ฃ๐ ๐ค๐ ๐จ๐ฉ๐๐ฃ๐ฉ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ ๐ฌ๐๐จ ๐๐๐ซ๐๐ก๐ค๐ฅ๐๐ ๐๐ฎ ๐ฉ๐๐ ๐ผ๐๐๐๐๐ข๐๐ ๐๐๐จ๐๐๐ง๐๐ ๐พ๐ค๐ฃ๐จ๐ค๐ง๐ฉ๐๐ช๐ข
๐๐๐๐ข๐ง๐ข๐ญ๐ stent thrombosis is confirmed by
angiographic or autopsy evidence of thrombus in the setting of an acute coronary syndrome, and
๐๐ซ๐จ๐๐๐๐ฅ๐ stent thrombosis is defined as
unexplained death within 30 days after stent implantation or acute MI involving the target vessel territory without angiographic confirmation.
๐ผ๐๐ช๐ฉ๐ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ ๐ค๐๐๐ช๐ง๐จ ๐ฌ๐๐ฉ๐๐๐ฃ 24 ๐๐ค๐ช๐ง๐จ
(excluding intraprocedural events within
the catheterization laboratory),
๐๐ช๐๐๐๐ช๐ฉ๐ ๐๐๐ฉ๐ฌ๐๐๐ฃ 1 ๐๐๐ฎ ๐๐ฃ๐ 30 ๐๐๐ฎ๐จ,
๐๐๐ง๐ก๐ฎ ๐ฌ๐๐ฉ๐๐๐ฃ 30 ๐๐๐ฎ๐จ
(counting both acute and subacute events),
๐๐๐ฉ๐ ๐๐๐ฉ๐ฌ๐๐๐ฃ 30 ๐๐๐ฎ๐จ ๐๐ฃ๐ 1 ๐ฎ๐๐๐ง, and
๐๐๐ง๐ฎ ๐๐๐ฉ๐ ๐๐๐ฉ๐๐ง 1 ๐ฎ๐๐๐ง.
โโโโโโโโโโโโโโโโโโโโโโโโ
๐๐๐ง๐ค๐ข๐๐ค๐ฉ๐๐ ๐ค๐๐๐ก๐ช๐จ๐๐ค๐ฃ is classified as :-
โซ๏ธ ๐๐ง๐๐ข๐๐ง๐ฎ if it is directly related to the stent implantation
โซ๏ธ ๐๐๐๐ค๐ฃ๐๐๐ง๐ฎ if it occurs at the stent site after
a subsequent intervention to the target lesion.
Risk Factors Stent thrombosis can occur as
a result of many reasons, including โขโขโข
๐๐๐ฉ๐๐๐ฃ๐ฉ-๐ง๐๐ก๐๐ฉ๐๐ ๐๐๐๐ฉ๐ค๐ง๐จ
โโโโโโโโโโโ-
Patients who ๐ฅ๐ง๐๐จ๐๐ฃ๐ฉ ๐ฌ๐๐ฉ๐ thrombotic ACS, Smokers, and Diabetes and/or chronic kidney as well as severely depressed left ventricular function
are all more prone to stent thrombosis.
High residual ๐ฅ๐ก๐๐ฉ๐๐ก๐๐ฉ ๐ง๐๐๐๐ฉ๐๐ซ๐๐ฉ๐ฎ after treatment,
which can be seen in patients with genetic mutations in the enzyme responsible for
converting clopidogrel to its active metabolite,
has been associated with stent thrombosis.
๐๐๐จ๐๐ค๐ฃ ๐๐๐๐ฉ๐ค๐ง๐จ that increase risk of thrombosis include diffuse disease with long stented segments, small vessels, bifurcation disease, and significant inflow or outflow lesions proximal or distal to the stent.
๐๐ง๐ค๐๐๐๐ช๐ง๐๐ก ๐๐๐๐ฉ๐ค๐ง๐จ :
โโโโโโโโโ
โซ๏ธinadequate stent expansion and/or apposition,
โซ๏ธStent type used (i.e., BMS or DES),
โซ๏ธExcessive stent overlap, and
โซ๏ธEdge dissections limiting inflow or outflow.
โซ๏ธStrut fracture linked to +Risk of thrombosis.
The thicker struts of earlier generation BMS and DES systems have been associated with increased risk of stent thrombosis, and this may have implications in the thrombosis risk of first-generation bioabsorbable scaffolds.
In addition, the polymers used in certain first-generation DES systems may be inherently throm-bogenic and/or prone to mechanical deformation after implantation, serving as a nidus for thombus formation.
๐๐ค๐จ๐ฉ๐ฅ๐ง๐ค๐๐๐๐ช๐ง๐๐ก ๐ง๐๐จ๐ ๐๐๐๐ฉ๐ค๐ง๐จ:-
โโโโโโโโโโโโโ-
โซ๏ธ ๐iscontinuation Early of dual-antiplatelet
(although the ideal length of treatment
varies by the specific stent system),
โซ๏ธ ๐elayed re-endothelialization of stent struts
in DES systems due to antiproliferative agent
โซ๏ธ ๐evelopment of neoatherosclerosis within
the stent leading to plaque rupture.
Specific strategies aimed at reducing the occurrence of stent thrombosis are shown image๐
โโโโโโโโโโโโโโโโโโโโโโโโ-
๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐จ๐ ๐ฌ๐ญ๐๐ง๐ญ ๐ญ๐ก๐ซ๐จ๐ฆ๐๐จ๐ฌ๐ข๐ฌ,
especially when presenting as acute MI,
is almost always ๐๐ข๐๐ง๐๐๐ฃ๐ฉ ๐๐พ๐.
โช๏ธOptions for restoring perfusion include :
โซ๏ธ ๐๐๐ง๐ค๐ข๐๐๐๐ฉ๐ค๐ข๐ฎ either aspiration or mechanical
#CCU_CORONARY
Stent Thrombosis, although rare (occur in <1%
patients within the first year), is one of the most
serious complications following stent placement.
More than 80% of patients who experience
stent thrombosis present with acute MI, and
30-day mortality rates in patients with stent
thrombosis range from 10% to 25%.
As a result, prevention and treatment of
this complication are of utmost importance.
โโโโโโโโโโโโโโโโโโโโโโโโ-
๐๐๐ ๐ข๐ค๐จ๐ฉ ๐ฌ๐๐๐๐ก๐ฎ ๐ช๐จ๐๐ ๐๐๐๐๐ฃ๐๐ฉ๐๐ค๐ฃ ๐๐ฃ๐ซ๐ค๐ก๐ซ๐๐ฃ๐ ๐ฉ๐๐ ๐๐ก๐๐จ๐จ๐๐๐๐๐๐ฉ๐๐ค๐ฃ ๐๐ฃ๐ ๐ฉ๐๐ข๐๐ฃ๐ ๐ค๐ ๐จ๐ฉ๐๐ฃ๐ฉ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ ๐ฌ๐๐จ ๐๐๐ซ๐๐ก๐ค๐ฅ๐๐ ๐๐ฎ ๐ฉ๐๐ ๐ผ๐๐๐๐๐ข๐๐ ๐๐๐จ๐๐๐ง๐๐ ๐พ๐ค๐ฃ๐จ๐ค๐ง๐ฉ๐๐ช๐ข
๐๐๐๐ข๐ง๐ข๐ญ๐ stent thrombosis is confirmed by
angiographic or autopsy evidence of thrombus in the setting of an acute coronary syndrome, and
๐๐ซ๐จ๐๐๐๐ฅ๐ stent thrombosis is defined as
unexplained death within 30 days after stent implantation or acute MI involving the target vessel territory without angiographic confirmation.
๐ผ๐๐ช๐ฉ๐ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ ๐ค๐๐๐ช๐ง๐จ ๐ฌ๐๐ฉ๐๐๐ฃ 24 ๐๐ค๐ช๐ง๐จ
(excluding intraprocedural events within
the catheterization laboratory),
๐๐ช๐๐๐๐ช๐ฉ๐ ๐๐๐ฉ๐ฌ๐๐๐ฃ 1 ๐๐๐ฎ ๐๐ฃ๐ 30 ๐๐๐ฎ๐จ,
๐๐๐ง๐ก๐ฎ ๐ฌ๐๐ฉ๐๐๐ฃ 30 ๐๐๐ฎ๐จ
(counting both acute and subacute events),
๐๐๐ฉ๐ ๐๐๐ฉ๐ฌ๐๐๐ฃ 30 ๐๐๐ฎ๐จ ๐๐ฃ๐ 1 ๐ฎ๐๐๐ง, and
๐๐๐ง๐ฎ ๐๐๐ฉ๐ ๐๐๐ฉ๐๐ง 1 ๐ฎ๐๐๐ง.
โโโโโโโโโโโโโโโโโโโโโโโโ
๐๐๐ง๐ค๐ข๐๐ค๐ฉ๐๐ ๐ค๐๐๐ก๐ช๐จ๐๐ค๐ฃ is classified as :-
โซ๏ธ ๐๐ง๐๐ข๐๐ง๐ฎ if it is directly related to the stent implantation
โซ๏ธ ๐๐๐๐ค๐ฃ๐๐๐ง๐ฎ if it occurs at the stent site after
a subsequent intervention to the target lesion.
Risk Factors Stent thrombosis can occur as
a result of many reasons, including โขโขโข
๐๐๐ฉ๐๐๐ฃ๐ฉ-๐ง๐๐ก๐๐ฉ๐๐ ๐๐๐๐ฉ๐ค๐ง๐จ
โโโโโโโโโโโ-
Patients who ๐ฅ๐ง๐๐จ๐๐ฃ๐ฉ ๐ฌ๐๐ฉ๐ thrombotic ACS, Smokers, and Diabetes and/or chronic kidney as well as severely depressed left ventricular function
are all more prone to stent thrombosis.
High residual ๐ฅ๐ก๐๐ฉ๐๐ก๐๐ฉ ๐ง๐๐๐๐ฉ๐๐ซ๐๐ฉ๐ฎ after treatment,
which can be seen in patients with genetic mutations in the enzyme responsible for
converting clopidogrel to its active metabolite,
has been associated with stent thrombosis.
๐๐๐จ๐๐ค๐ฃ ๐๐๐๐ฉ๐ค๐ง๐จ that increase risk of thrombosis include diffuse disease with long stented segments, small vessels, bifurcation disease, and significant inflow or outflow lesions proximal or distal to the stent.
๐๐ง๐ค๐๐๐๐ช๐ง๐๐ก ๐๐๐๐ฉ๐ค๐ง๐จ :
โโโโโโโโโ
โซ๏ธinadequate stent expansion and/or apposition,
โซ๏ธStent type used (i.e., BMS or DES),
โซ๏ธExcessive stent overlap, and
โซ๏ธEdge dissections limiting inflow or outflow.
โซ๏ธStrut fracture linked to +Risk of thrombosis.
The thicker struts of earlier generation BMS and DES systems have been associated with increased risk of stent thrombosis, and this may have implications in the thrombosis risk of first-generation bioabsorbable scaffolds.
In addition, the polymers used in certain first-generation DES systems may be inherently throm-bogenic and/or prone to mechanical deformation after implantation, serving as a nidus for thombus formation.
๐๐ค๐จ๐ฉ๐ฅ๐ง๐ค๐๐๐๐ช๐ง๐๐ก ๐ง๐๐จ๐ ๐๐๐๐ฉ๐ค๐ง๐จ:-
โโโโโโโโโโโโโ-
โซ๏ธ ๐iscontinuation Early of dual-antiplatelet
(although the ideal length of treatment
varies by the specific stent system),
โซ๏ธ ๐elayed re-endothelialization of stent struts
in DES systems due to antiproliferative agent
โซ๏ธ ๐evelopment of neoatherosclerosis within
the stent leading to plaque rupture.
Specific strategies aimed at reducing the occurrence of stent thrombosis are shown image๐
โโโโโโโโโโโโโโโโโโโโโโโโ-
๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐จ๐ ๐ฌ๐ญ๐๐ง๐ญ ๐ญ๐ก๐ซ๐จ๐ฆ๐๐จ๐ฌ๐ข๐ฌ,
especially when presenting as acute MI,
is almost always ๐๐ข๐๐ง๐๐๐ฃ๐ฉ ๐๐พ๐.
โช๏ธOptions for restoring perfusion include :
โซ๏ธ ๐๐๐ง๐ค๐ข๐๐๐๐ฉ๐ค๐ข๐ฎ either aspiration or mechanical
โซ๏ธ and/or ๐๐๐ก๐ก๐ค๐ค๐ฃ ๐๐ฃ๐๐๐ค๐ฅ๐ก๐๐จ๐ฉ๐ฎ with
โซ๏ธ Administration of more potent pharmacologic
agents such as ๐๐ก๐ฎ๐๐ค๐ฅ๐ง๐ค๐ฉ๐๐๐ฃ ๐๐๐/๐๐๐๐ ๐๐ฃ๐๐๐๐๐ฉ๐ค๐ง๐จ
at the discretion of the operator.
โช๏ธ๐ผ๐๐๐ช๐ฃ๐๐ฉ๐๐ซ๐ ๐๐ข๐๐๐๐ฃ๐ ๐ฌith modalities such as
๐๐๐๐ ๐ค๐ง ๐๐พ๐ can be very helpful in discerning
the underlying etiology of the thrombosis
(e.g., stent underexpansion/malapposition or
residual dissection) and is recommended prior to
further balloon manipulation of the stented site.
โช๏ธ ๐ผ๐๐๐๐ฉ๐๐ค๐ฃ๐๐ก ๐จ๐ฉ๐๐ฃ๐ฉ๐จ ๐๐ง๐ ๐ฉ๐ฎ๐ฅ๐๐๐๐ก๐ก๐ฎ ๐๐ซ๐ค๐๐๐๐ unless
a mechanical reason for the thrombosis
(such as edge dissection) is seen.
โช๏ธ ๐๐ซ๐๐ก๐ช๐๐ฉ๐๐ค๐ฃ ๐ฃ๐ค๐ฃ๐ข๐๐๐๐๐ฃ๐๐๐๐ก ๐๐๐ช๐จ๐๐จ ๐ค๐ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ
such as hypercoagulable state, thrombocytosis,
or aspirin/clopidogrel resistance should considered.
โช๏ธ ๐๐จ๐๐๐ก๐๐ฉ๐๐ค๐ฃ ๐ค๐ ๐ข๐๐๐ฃ๐ฉ๐๐ฃ๐๐ฃ๐๐ ๐๐ฃ๐ฉ๐๐ฅ๐ก๐๐ฉ๐๐ก๐๐ฉ ๐ฉ๐๐๐ง๐๐ฅ๐ฎ
(e.g., from clopidogrel to more potent oral
antiplatelet therapies such as prasugrel or
ticagrelor) is standard.
https://www.tg-me.com/cardiology
โซ๏ธ Administration of more potent pharmacologic
agents such as ๐๐ก๐ฎ๐๐ค๐ฅ๐ง๐ค๐ฉ๐๐๐ฃ ๐๐๐/๐๐๐๐ ๐๐ฃ๐๐๐๐๐ฉ๐ค๐ง๐จ
at the discretion of the operator.
โช๏ธ๐ผ๐๐๐ช๐ฃ๐๐ฉ๐๐ซ๐ ๐๐ข๐๐๐๐ฃ๐ ๐ฌith modalities such as
๐๐๐๐ ๐ค๐ง ๐๐พ๐ can be very helpful in discerning
the underlying etiology of the thrombosis
(e.g., stent underexpansion/malapposition or
residual dissection) and is recommended prior to
further balloon manipulation of the stented site.
โช๏ธ ๐ผ๐๐๐๐ฉ๐๐ค๐ฃ๐๐ก ๐จ๐ฉ๐๐ฃ๐ฉ๐จ ๐๐ง๐ ๐ฉ๐ฎ๐ฅ๐๐๐๐ก๐ก๐ฎ ๐๐ซ๐ค๐๐๐๐ unless
a mechanical reason for the thrombosis
(such as edge dissection) is seen.
โช๏ธ ๐๐ซ๐๐ก๐ช๐๐ฉ๐๐ค๐ฃ ๐ฃ๐ค๐ฃ๐ข๐๐๐๐๐ฃ๐๐๐๐ก ๐๐๐ช๐จ๐๐จ ๐ค๐ ๐ฉ๐๐ง๐ค๐ข๐๐ค๐จ๐๐จ
such as hypercoagulable state, thrombocytosis,
or aspirin/clopidogrel resistance should considered.
โช๏ธ ๐๐จ๐๐๐ก๐๐ฉ๐๐ค๐ฃ ๐ค๐ ๐ข๐๐๐ฃ๐ฉ๐๐ฃ๐๐ฃ๐๐ ๐๐ฃ๐ฉ๐๐ฅ๐ก๐๐ฉ๐๐ก๐๐ฉ ๐ฉ๐๐๐ง๐๐ฅ๐ฎ
(e.g., from clopidogrel to more potent oral
antiplatelet therapies such as prasugrel or
ticagrelor) is standard.
https://www.tg-me.com/cardiology
Telegram
Cardiology
๐จโ๐ป @dr_navruz
Dear Valued Subscribers,
Lately, Iโve been receiving many messages inquiring whether the scientific content of this channel can be shared in other groups and channels. Absolutely โ sharing is encouraged! This channel was created with the goal of supporting students and doctors in strengthening and revising their medical knowledge.
๐ข Feel free to share useful content and invite your colleagues or classmates to join. The more we learn together, the stronger our medical community becomes.
Thank you for being a part of this growing educational space!
With appreciation,
Admin
Lately, Iโve been receiving many messages inquiring whether the scientific content of this channel can be shared in other groups and channels. Absolutely โ sharing is encouraged! This channel was created with the goal of supporting students and doctors in strengthening and revising their medical knowledge.
๐ข Feel free to share useful content and invite your colleagues or classmates to join. The more we learn together, the stronger our medical community becomes.
Thank you for being a part of this growing educational space!
With appreciation,
Admin
Cardiology pinned ยซDear Valued Subscribers, Lately, Iโve been receiving many messages inquiring whether the scientific content of this channel can be shared in other groups and channels. Absolutely โ sharing is encouraged! This channel was created with the goal of supportingโฆยป
M-Mode in PLAX View:
Understanding Aortic, Mitral, and Left Ventricular
https://www.tg-me.com/cardiology
Understanding Aortic, Mitral, and Left Ventricular
https://www.tg-me.com/cardiology