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01.05.2011 | Schwerpunkt/CME

Koronare Stent-Thrombosen

Was gibt es Neues für 2011?

verfasst von: M. Oberhänsli, S. Puricel, M. Togni, Prof. Dr. S. Cook

Erschienen in: Herz | Ausgabe 3/2011

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Zusammenfassung

Stent-Thrombosen (ST) stellen eine schwerwiegende Komplikation der perkutanen Behandlung der koronaren Herzkrankheit dar und sind mit einer hohen Sterblichkeitsrate von bis zu 45% verbunden. Bare-Metal-Stents (BMS) und Drug-Eluting-Stents (DES) haben eine ähnliche Inzidenz für frühe (0,6–1,2%) und späte (0,3–0,4%) ST. Sehr späte ST (über 1 Jahr nach Stent-Implantation) weisen einen unabhängigen pathogenetischen Mechanismus auf und werden fast ausschließlich nach der Implantation von DES der 1. Generation mit einer Rate von 0,6% Ereignissen/Jahr beobachtet. Starke Determinanten für das Auftreten früher und später ST sind eine unzureichende Thrombozytenaggregationshemmertherapie, ein akutes Koronarsyndrom, Auftreten von Komplikationen während des Eingriffs, das unmittelbare postprozedurale Resultat sowie Begleiterkrankungen des Patienten. Sehr späte ST haben eine eigenständige Pathogenese – eine direkt medikamentös bedingte Hemmung der Reendothelialisierung und eine durch das Medikament oder das Polymer des Stent verursachte chronische Entzündung der Gefäßwand mit in der Folge gestörter Reendothelialisierung, welche zu einem positivem Remodelling der Arterienwand mit sekundärer Malapposition des Stent führt. In der Prävention der ST spielt die duale Thrombozytenaggregationshemmertherapie eine zentrale Rolle. Das vorzeitige Absetzen dieser Therapie in den ersten 6 Monaten nach Stent-Implantation führt zu einer erhöhten Inzidenz von ST. Zur Prävention gehört auch der Fortschritt. Erfreulicherweise haben die Verwendung von DES der 2. Generation und neue Thrombozytenaggregationshemmertherapien die Inzidenz der ST signifikant verringert.

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Titel: Koronare Stent-Thrombosen
Was gibt es Neues für 2011?
verfasst von: M. Oberhänsli
S. Puricel
M. Togni
Prof. Dr. S. Cook
Publikationsdatum: 01.05.2011
Verlag: Urban and Vogel
Erschienen in: Herz / Ausgabe 3/2011
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-011-3464-1

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