1. Incomplete Apposition Implicated in Stent Thrombosis

    Another idea would be for clinicians to use OCT to evaluate patients who need to stop taking clopidogrel. “If there is no malapposition, if all struts are covered, then you really don’t need dual antiplatelet therapy,” she said “But if someone had to go for surgery and he’s 1 year out and he’s got a lot of uncovered struts, I would say to the surgeon, ‘You’ve got to keep him on Plavix, I’m sorry. Otherwise he’s going to die. You’re going to create late stent thrombosis.’”
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    1. It is a dangerous thing to put drug-eluting stents in patients who present with acute myocardial infarction...The fibrous cap is thin and has very few smooth muscle cells in it . . . and underneath, this necrotic core has no cells in it. So how does it heal? It needs cells to come in.... “Now you put a drug on top of that [by implanting DES]. It isn’t going to be allowed to heal. The reason [physicians] get away with this is patients are on dual antiplatelet therapy.