Dedicated thrombus-containing stent platforms

Coronary atherosclerosis is the main underlying cause of ischemic heart disease, and plaque disruption with superimposed thrombosis is the main cause of acute coronary syndrome The presence of an intracoronary thrombus is associated with increased incidence of percutaneous coronary intervention (PCI)-related complications (e.g., distal embolization and/or no-reflow phenomenon) as well as short- and long-term mortality. Several therapeutic measures, both pharmacologic and mechanical, were evaluated to prevent embolization with only partial success and numerous technical shortcomings. Thus, novel stents, designed as “built-in” and permanent embolic protection devices were introduced, the most widely investigated being the MGuard, a balloon-expandable stent covered by an ultrathin flexible mesh of the polymer polyethylene terephthalate, and the STENTYS self-expanding and self-apposing nitinol stent. Clinical trials have shown strong signals of better procedural outcomes with these stents, mainly in primary PCI of patients with ST-segment elevation myocardial infarction and revascularization of saphenous vein grafts. However, they were underpowered to discern differences in the most critical clinical outcomes. This chapter reviews the rationale, design, technical characteristics, and clinical evidence behind the dedicated thrombus-capturing and -stabilizing stent platforms, to better define their potential and unique role in the landscape of contemporary interventional cardiology.