To review and analyze the pathophysiology, risk factors, and prevention strategies of early stent thrombosis (EST) through a synthesis of published studies and clinical data.

A comprehensive literature review and meta-analysis of studies (2005–2024) focusing on:
* Incidence and timing of early stent thrombosis (≤30 days post-PCI)* Pathophysiological mechanisms (endothelial dysfunction, malapposition, thrombosis)* Clinical and procedural risk factors* Efficacy of antiplatelet and antithrombotic regimens
Data were extracted from PubMed, Scopus, and major interventional cardiology trials.

The findings identified impaired endothelial healing, stent malapposition, and systemic pro-thrombotic states as pivotal pathophysiological contributors. Both patient-related factors (such as diabetes mellitus, smoking, and genetic predisposition) and procedural factors (including stent design, size selection, and deployment technique) were shown to significantly influence the risk of early stent thrombosis. Evidence regarding optimal duration and selection of antiplatelet therapy—particularly with novel P2Y12 inhibitors—was summarized, emphasizing their role in risk reduction.

Early stent thrombosis remains a multifactorial and life-threatening event in PCI.Key preventive strategies include:
* Careful stent sizing and high-pressure post-dilatation* Adherence to potent and individualized DAPT regimens* Platelet function/genetic testing in high-risk patients* Close early post-procedure follow-up
A multidisciplinary and personalized approach can significantly reduce the incidence of EST and improve patient outcomes.