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NBME 24 Answers

nbme24/Block 4/Question#43

A 72-year-old woman with coronary artery disease ...

Neointima formation in the right coronary stent

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 +21  upvote downvote
submitted by xxabi(80),

Stent thrombosis vs re-stenosis. Stent thrombosis is an acute occlusion of a coronary artery stent, which often results in acute coronary syndrome. Can be prevented by dual antiplatelet therapy or drug-eluting stents. Re-stenosis is the gradual narrowing of the stent lumen due to neointimal proliferation, resulting in anginal symptoms.


 +0  upvote downvote
submitted by sweetmed(27),

Stent Restenosis occurs from scar tissue grows over stent causing “neointimal hyperplasia” and narrowing, ischemia symptoms return Tx: prevent by using drig eluting stents eg. Sirolimus. Thrombosis Post stenosis is Acute, stent serves as nidus for thrombus formation usually 2/2 missing mediation. Tx: prevent by using dual antiplatelet treatment [aspirin+clopidogrel/ticagrelor]. After 1 year, endothelization of stent occurs and there is a lower risk of thrombus, Tx lowered to just aspirin.