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Assessing Stent Thrombosis: Complex vs. Simple Techniques and Their Associated Risks

This presentation by David Hildick-Smith from the Sussex Cardiac Centre examines the risks associated with complex stenting techniques compared to simpler approaches, particularly focusing on stent thrombosis. It analyzes factors such as the outcomes of two-stent techniques versus single-stent techniques, the influence of operator experience, and the implications of registry data. The findings suggest that the risk of stent thrombosis is higher with complex stenting, especially in less skilled hands, making a case for critically evaluating stenting strategies in clinical practice.

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Assessing Stent Thrombosis: Complex vs. Simple Techniques and Their Associated Risks

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Presentation Transcript

  1. STENT THROMBOSIS Complex and Simple techniques: The same risk? David Hildick-Smith Sussex Cardiac Centre Brighton, UK

  2. No • The risk with complex stenting is higher

  3. 2 aspects • Intuitive • Scientific

  4. Intuitive • Could the risk be less with 2 stent technique than with single? • For an optimal technique, will the risk be the same for a one stent and a two-stent technique? • For a badly done case, will the risk be higher with a two stent rather than a one stent technique? • How many 2-stent cases have been done - 50,000? • Have they all been done well?

  5. Scientific • Initial 2-stent DES studies • Colombo 2004 • 3.5% early stent thrombosis in double-stent versus 1% in single stent

  6. Prior to routine kissing • Subsequently many randomised studies…

  7. Stent thrombosis

  8. This randomised trial data almost all relates to the short to medium term when all patients are on dual antiplatelets

  9. Lets look at a larger dataset • Registry better than Randomised? • Registry reflects usual practice • Much larger numbers • Techniques are heterogenous

  10. 0.05 0.04 0.03 0.02 0.01 0 0 365 730 1095 Stent Thrombosis in J-Cypher Registry ARC Definite Between 30 Days and 3 Years Slope 0.28% / Year Follow-up interval (Days) 30 Days 1 Yr. 2 Yrs. 3 Yrs. Cumulative incidences0.36%0.61%0.84%1.18% n of pts at risk 12,824 12,625 11,843 9,036 4,191 # Events: Not yet fully adjudicated

  11. Predictors of LST / VLST Multivariable analysis LST / VLST in 67 lesions among 16,801 lesions treated exclusively by Cypher Factors R.R. 95%C.I. P Value Hemodialysis 1.91 (1.29 - 2.65) 0.002 ESRD (e-GFR < 30/Non-HD) 1.81 (1.2 - 2.65) 0.007 Two stents for bifurcation 1.81 (1.17 - 2.59) 0.01 Those variables with p value < 0.1 in the univariable analysis were incorporated into the multivariable model.

  12. CONCLUSION • Stent thrombosis rates are (intuitively and) scientifically found to be greater for two stent techniques

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