Mechanisms and Diagnostic Strategies of In-Stent Thrombosis Following Coronary Stent Implantation

Percutaneous coronary intervention (PCI) is currently the mainstay of revascularization therapy for coronary heart disease. However, as one of the most serious complications following PCI, in-stent thrombosis, despite its low incidence, has an extremely high fatality rate and severely affects patient prognosis. The formation of in-stent thrombosis is a complex pathophysiological process involving multiple factors and interconnected links, including mechanical vascular endothelial injury, abnormal platelet activation, coagulation system activation, inflammatory response, and hemodynamic disturbances. From the perspective of clinical diagnosis and treatment, this article systematically reviews the definition and classification of in-stent thrombosis, risk factors, and pathophysiological mechanisms, with emphasis on the central role of hemodynamic disturbances (including abnormal wall shear stress, strut configuration effects, malapposition, and undersizing) in thrombus formation. It summarizes currently widely used clinical diagnostic methods (coronary angiography, intravascular ultrasound, optical coherence tomography) and prevention and treatment strategies (antiplatelet therapy, procedural optimization, novel stent technologies), and introduces the application progress of numerical simulation techniques such as computational fluid dynamics in thrombus risk prediction and stent optimization design. This article aims to provide theoretical reference for clinicians to deepen their understanding of in-stent thrombosis and optimize diagnosis and treatment strategies, while also providing direction for the development of novel antithrombotic stents.