Stent thrombosis, Defination, Classification, TIMI grade, management

1. Stent Thrombosis

2. • Rare but devastating complication
• <1% with in 30 days of stenting, 0.2% to 6%
every year
• Associated with higher thrombus burden with
less frequent procedural success which results
in higher rate of death, recurrent MI and
recurrent ST

3. Risk Factors of ST
• Stent related:
1. Early (<30 days) and late ST ( 30 days to 1
year) similar in BMS and DES
2. Very late (> 1 yr) ST common in DES
• Procedure related:
1. Incomplete apposition
2. Inadequate expansion
3. Stent edge dissection

4. • Vessel related:
1. Long lesion
2. Small diameter of artery
3. Complex morphology of lesion ( Bifurcation
lesion, CTO)
• Patient related:
1. DM 2. Impaired LV function 3. Renal disease
4. Non compliance to DAPT

7. Grade 1

8. Grade 2

9. Grade 5

10. Management of Thrombus burden
Small thrombus burden (Grade 0-1):
Direct angioplasty and stenting
Moderate to large thrombus burden (Grade 2-5):
Manual thrombosuction in STEMI (class IIa)
Embolic protection device in SVG intervention
Aim is to establish TIMI III flow. If not possible defer
PCI (4-16 hours) with intracoronary gp IIb-IIIa
antagonist