| Post-PCI management with DES for minor and major non-cardiac surgery |
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Jung-Sun Kim, Ph D |
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한림대학교 의과대학 내과학교실 강동성심병원 심혈관센터 |
| 특집: 약물 용출 스텐트 시술후 비 심장 수술(non-cardiac surgery) 시 환자 관리 |
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김 중 선, Ph D |
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| Abstract |
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In-stent restenosis has been reduced significantly after introduction of drug eluting stent (DES). But concern of
long-term safety has emerged because of inappropriate neointimal coverage over stent related with cytotoxic drug and
polymer. Recently, non-cardiac surgery after DES implantation is increasing and use of anti-platelet agent during operation
might be problematic. Non-cardiac surgery might increase the risk of stent thrombosis, which was related with myocardial
infarction and death, particularly in DES. Preoperative discontinuation of dual-antiplatelet therapy (DAT) and early surgery
after stent implantation have been well known factors of perioperative stent thrmbosis. Thus, current guideline for
anti-platelet therapy in non-cardiac surgery was established in patients after balloon angioplasty and bare metal stent based
on duration of DAT according to the period of complete endothelization and neointimal growth after stent implantation.
But, there are controversies and little evidence in DES for timing and use of DAT to reduce the stent thrombosis in
non-cardiac surgery. Therefore, I reviewed the existing data about stent thrombosis after noncardiac surgery, the impact
of delay from surgery and discontinuation of DAT. Based on these published data, I suggested recommendations for
patients who require noncardiac surgery after DES. (Korean J Med 75:392-397, 2008) |
| Key Words:
Stent; Surgery; Thrombosis |
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