The key difference between stent thrombosis and restenosis is that stent thrombosis occurs when there is complete occlusion of the artery due to the formation of thrombus in the stent, while restenosis occurs when a part of the artery that was previously treated for blockage through a stent or balloon angioplasty becomes narrow again due to overgrowth of scar tissue.
Percutaneous coronary intervention is a minimally invasive procedure that helps to open clogged coronaries in conditions such as atherosclerosis. This can improve symptoms of blocked arteries. Percutaneous coronary intervention can be performed through stent or angioplasty. Stent thrombosis and restenosis are two complications of percutaneous coronary intervention.
CONTENTS
1. Overview and Key Difference
2. What is Stent Thrombosis
3. What is Restenosis
4. Similarities – Stent Thrombosis and Restenosis
5. Stent Thrombosis vs Restenosis in Tabular Form
6. Summary – Stent Thrombosis vs Restenosis
What is Stent Thrombosis?
Stent thrombosis occurs when an implanted coronary stent causes a thrombotic occlusion. It is also known as an abrupt vessel closure due to the formation of a thrombus in the stent. This can ultimately lead to myocardial infarction. It occurs in about 5% of patients that undergo a coronary stent procedure in percutaneous coronary intervention. Moreover, it is a severe complication with a mortality rate of 45% and a recurrent rate of 20% within five years.
Stent thrombosis can cause symptoms of acute coronary syndrome such as chest pain and discomfort, pain in one or both arms, jaw, neck, back, or stomach, shortness of breath, dizziness or lightheadedness, nausea, and sweating. Stent thrombosis is mainly caused by nonadherence to dual antiplatelet therapy (DAPT). This means discontinuing dual antiplatelet therapy (DAPT) within six months of coronary stent implantation leads to stent thrombosis.
Stent thrombosis can be diagnosed through a patient’s history, physical examination, electrocardiogram, echocardiogram, and test for cardiac enzymes. Furthermore, stent thrombosis is treated through aspiration thrombectomy, angioplasty, additional stent implantation, and optimization of applied antiplatelet therapy (DAPT).
What is Restenosis?
Restenosis is a blockage or narrowing that comes back in the portion of the coronary artery previously treated with a stent or balloon angioplasty. It is also a reduction in the diameter of the blood vessel lumen after stent or balloon angioplasty due to the overgrowth of scar tissue. Restenosis can be observed in about 1 in 4 people who undergo angioplasty with stenting. Moreover, about 4 in 10 people who undergo balloon angioplasty without stenting also experience restenosis. The symptoms of restenosis may include cold sweats or clamminess, dizziness or lightheadedness, fatigue, heart palpitations, nausea, shortness of breath, and pain in the shoulder or arm. Restenosis is due to too much scar tissue in people with risks such as high cholesterol, kidney disease, smoking, uncontrolled diabetes, or high blood pressure.
Figure 01: Restenosis
Restenosis is diagnosed through physical examination, exercise stress test, cardiac catheterization, coronary computed tomography angiogram (CCTA), fractional flow reserve (FFR), and intravascular ultrasound (IVUS). Furthermore, restenosis can be treated by increasing or adding medications to control the symptoms, repeated angioplasty, heart bypass surgery, and vascular brachytherapy.
What are the Similarities Between Stent Thrombosis and Restenosis?
- Stent thrombosis and restenosis are two complications of percutaneous coronary intervention.
- Both may show similar symptoms, such as chest pain, arm and shoulders pain, shortness of breath, etc.
- Both can be diagnosed through a patient’s history, physical examination, and imaging tests.
- They are treated through medicines, nonsurgical procedures, and surgeries.
What is the Difference Between Stent Thrombosis and Restenosis?
Stent thrombosis occurs when there is complete occlusion of the artery due to the formation of a thrombus in the stent, while restenosis occurs when a part of the artery that was previously treated for blockage through a stent or balloon angioplasty becomes narrow again due to overgrowth of scar tissue. Thus, this is the key difference between stent thrombosis and restenosis. Furthermore, stent thrombosis results in the acute occlusion of the artery. On the other hand, restenosis results in slow and progressive occlusion of the artery.
The infographic below presents the differences between stent thrombosis and restenosis in tabular form for side-by-side comparison.
Summary – Stent Thrombosis vs Restenosis
Percutaneous coronary intervention improves the blood supply to the ischemic tissue. It can be performed through angioplasty with a stent and balloon angioplasty. However, these procedures sometimes lead to complications such as stent thrombosis and restenosis. Stent thrombosis is the abrupt vessel closure due to the formation of a thrombus in the stent. On the other hand, restenosis is the reduction in the diameter of the blood vessel lumen after stent or balloon angioplasty due to the overgrowth of scar tissue. So, this summarizes the difference between stent thrombosis and restenosis.
Reference:
1.“Stent Thrombosis.” An Overview | ScienceDirect Topics.
2. “Restenosis.” – StatPearls – NCBI Bookshelf.
Image Courtesy:
1. “Late Loss Restenosis” (CC0) via Commons Wikimedia