Thrombotic medications could replace stents in some patients, intravascular imaging shows

Stents have long been the preferred treatment for reopening blocked arteries in patients who’ve suffered a heart attack or other heart conditions. But new research suggests that physicians may be able to forgo stent procedures and instead give patients anti-thrombotic medications.

The new study, titled EROSION (Effective Anti-thrombotic Therapy without Stenting: Intravascular OCT-based Management in Plaque Erosion), analyzes the effects of anti-thrombotic therapy, a drug that can increase blood flow through arteries and veins, and how it can help patients with acute coronary syndromes (ACS).

The study, published in European Heart Journal, was led by Ik-Kyung Jang, MD, PhD, a professor at Harvard Medical School and the director of the clinical trials program at the Massachusetts General Hospital in Boston.

"If this conservative approach without a metallic stent or polymer scaffold proves to be effective and safe, it may become a new treatment paradigm for over a quarter of patients with ACS, thereby abrogating stent-related early and late complications," Jang said in a statement.

Some ACS cases are best treated with stents, but a significant number of them could be treated with anti-thrombotic therapy. Studying more than 400 ACS patients that received coronary angiography, the researchers used an intracoronary imaging technique called optical coherence tomography (OCT) that helped them differentiate plaque erosion from plaque rupture in each patient.

In patients that qualified for anti-thrombotic treatment, clot volume decreased from 3.7 to 0.2 mm3 with minimal flow area increasing from 1.7 to 2.1 mm2, the study said.

"Currently all patients with ACS are uniformly treated with stenting regardless of underlying pathology," Jang said. "This study, for the first time, demonstrates that patients with ACS caused by erosion may benefit from a tailored therapy with anti-thrombotic medications. If we can identify ACS patients with erosion without an invasive procedure, those patients may be triaged to a conservative therapy pathway instead of invasive catheterization and stent implantation."