Stent thrombosis: Role of compliance and nonresponsiveness to antiplatelet therapy

Percutaneous coronary intervention with drug-eluting stents has revolutionized the management of patients with symptomatic coronary artery disease. Although this strategy significantly reduces the incidence of restenosis and repeat revascularization, concern has been raised about an increased frequency of late stent thrombosis with drug-eluting stents compared with bare-metal stents. The mechanism of stent thrombosis remains unclear, and various hypotheses have been described. Platelets are believed to play a pivotal role in the development of stent thrombosis, with pathological studies demonstrating an abundance of platelets within the occlusive thrombi. Premature discontinuation and nonadherence to antiplatelet therapy are considered important risk factors for late stent thrombosis. Early identification of vulnerable patients and definition of the role of antiplatelet nonresponsiveness in the development of stent thrombosis should be the focus of future diagnostic and therapeutic strategies.