Alejandro González Veliz: Can a Stent Cause a Heart Attack?
Alejandro González Veliz, Interventional Cardiologist at Institute of Cardiology and Cardiovascular Surgery, shared a post on LinkedIn:
“Can a stent cause a heart attack?
Yes – but it’s important to understand how.
Modern drug-eluting stents have dramatically reduced the risk of stent thrombosis, making it an uncommon complication.
However, when thrombosis occurs, it can cause acute coronary occlusion and myocardial infarction, often presenting as an acute coronary syndrome.
The mechanisms are multifactorial.
Early stent thrombosis may be related to mechanical problems such as underexpansion, malapposition, edge dissection, or significant residual disease, together with patient- and treatment-related factors such as premature interruption of antiplatelet therapy.
Years after implantation, the mechanism can be completely different.
Neoatherosclerosis can develop within the neointimal tissue covering the stent.
Lipid accumulation and plaque formation may eventually lead to plaque rupture, thrombosis, and very late stent failure.
And one important distinction:
Not every myocardial infarction in a patient with a stent is caused by the stent.
Patients can still develop plaque rupture, disease progression, or new culprit lesions elsewhere in the coronary tree.
That is why successful PCI does not end when the stent is deployed.
Optimal stent expansion and apposition, appropriate antithrombotic therapy, and aggressive secondary prevention all matter for long-term outcomes.
Current ACS recommendations also emphasize individualized antiplatelet strategies according to ischemic and bleeding risk.
The stent treats the lesion.
Long-term prevention treats the disease.”
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