Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

Journal of Thoracic Disease
Nicholas G KounisGeorge Hahalis

Abstract

Percutaneous transluminal coronary angioplasty with coronary stent implantation is a life-saving medical procedure that has become, nowadays, the most frequent performed therapeutic procedure in medicine. Plain balloon angioplasty, bare metal stents, first and second generation drug-eluting stents, bioresorbable and bioabsorbable scaffolds have offered diachronically a great advance against coronary artery disease and have enriched our medical armamentarium. Stented areas constitute vulnerable sites for endothelial damage, endothelial dysfunction, flow turbulence, hemorheologic changes, platelet dysfunction, coagulation changes and fibrinolytic disturbances. Implant surface attracts several proteins such as albumin, fibronectin, fibrinogen, and complement that lead to complement system activation. Macrophages recognize the implant as foreign substance due to protein adsorption and its continuous presence results in macrophage differentiation and fusion into foreign body giant cells. Polymer coating, stent metallic platforms and the released drugs can act as strong antigenic complex that apply continuous, repetitive, persistent and chronic hypersensitivity irritation to the coronary intima. The concomitant administration of oral...Continue Reading

Citations

Jan 13, 2018·Circulation Journal : Official Journal of the Japanese Circulation Society·Nicholas G KounisGeorge Hahalis
Dec 21, 2019·Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas·Zheng YangMin Qiu
Apr 11, 2018·Oxidative Medicine and Cellular Longevity·Nicholas E BuglakEdward S M Bahnson
Mar 5, 2020·Case Reports in Cardiology·Sohab S RadwanChristopher Barnett
Aug 28, 2020·APL Bioengineering·Wenzhen ZhuDong-An Wang
Oct 31, 2020·European Heart Journal. Case Reports·Tomohiro FujisakiNaoya Maehira

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