What are the most common complications following percutaneous coronary intervention (PCI) with cardiac stenting?

From the Guidelines

The most common complications following percutaneous coronary intervention (PCI) with cardiac stenting include stent thrombosis, bleeding, and vascular access site complications, with a focus on antithrombotic therapy to minimize these risks, as recommended in the 2024 ESC guidelines for the management of chronic coronary syndromes 1. The management of these complications is crucial to improve patient outcomes, particularly in terms of morbidity, mortality, and quality of life.

• Stent thrombosis is a potentially fatal complication that requires immediate dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor like clopidogrel, as stated in the guidelines 1.
• Bleeding complications are also a concern, occurring in a significant proportion of patients due to the required antiplatelet therapy, and the guidelines recommend discontinuing DAPT after 1-3 months in patients at high bleeding risk but not at high ischemic risk 1.
• Vascular access site complications, such as hematoma, pseudoaneurysm, and arteriovenous fistula, can occur in approximately 5% of cases, highlighting the need for careful monitoring and management. The guidelines also recommend considering prasugrel or ticagrelor instead of clopidogrel in patients undergoing high-thrombotic risk stenting, to minimize the risk of stent thrombosis 1. Overall, the management of complications following PCI with cardiac stenting requires careful consideration of the patient's individual risk factors and the use of evidence-based antithrombotic therapy, as outlined in the 2024 ESC guidelines 1.

From the Research

Common Complications of Percutaneous Coronary Intervention (PCI) with Cardiac Stenting

The most common complications following PCI with cardiac stenting include:

• Stent thrombosis, which is a catastrophic event that can occur in up to 1% of patients at 9 months after drug-eluting stent (DES) implantation 2
• Restenosis, which is the recurrence of narrowing in the stented artery, and can be reduced with the use of DES 3, 4
• In-stent neointimal proliferation, which can be treated with adjunctive intravascular brachytherapy, but may increase the risk of late stent occlusion 2
• Stent fracture, which can result in thrombosis, perforation, restenosis, and migration of the stent, and may be managed conservatively or with further intervention 5

Risk Factors for Complications

Certain factors can increase the risk of complications after PCI with cardiac stenting, including:

• Diabetes mellitus, which can increase the incidence of stent-mediated complications by 2-4-fold 6
• Discontinuation of antiplatelet therapy, such as clopidogrel, which can increase the risk of stent thrombosis 2
• Inadequate implantation of the stent, which can increase the risk of restenosis and thrombosis 4

Prevention and Treatment of Complications

Prevention and treatment of complications after PCI with cardiac stenting may involve:

• Dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine, which can reduce the risk of stent thrombosis and restenosis 2, 3
• Use of newer, more potent antiplatelet agents, which may be beneficial in patients with clopidogrel resistance 3
• Intravascular imaging, which can help provide optimal delivery of the stent and reduce the risk of complications 4
• Development of new stent technologies, such as biodegradable polymers and polymer-free DES, which may improve outcomes and reduce the risk of complications 6, 4