The article discusses the biological mechanisms and clinical implications of stent thrombosis, a severe complication following stent implantation. Despite the introduction of drug-eluting stents (DES), stent thrombosis remains a concern due to its high morbidity and mortality. The risk factors for stent thrombosis include procedure-related factors such as stent malapposition, stent length, and persistent slow coronary blood flow, as well as patient and lesion characteristics. The drugs released from DES can activate signal transduction pathways and inhibit cell proliferation, leading to impaired reendothelialization and delayed arterial healing. Additionally, the polymers used in DES can induce hypersensitivity reactions and contribute to thrombogenicity. The article highlights the need for large-scale and long-term clinical trials to better understand the true risk of stent thrombosis and to develop strategies to prevent it. It also explores potential future designs for DES, such as coatings that facilitate reendothelialization or combinations of prohealing substances with anti-restenotic drugs.The article discusses the biological mechanisms and clinical implications of stent thrombosis, a severe complication following stent implantation. Despite the introduction of drug-eluting stents (DES), stent thrombosis remains a concern due to its high morbidity and mortality. The risk factors for stent thrombosis include procedure-related factors such as stent malapposition, stent length, and persistent slow coronary blood flow, as well as patient and lesion characteristics. The drugs released from DES can activate signal transduction pathways and inhibit cell proliferation, leading to impaired reendothelialization and delayed arterial healing. Additionally, the polymers used in DES can induce hypersensitivity reactions and contribute to thrombogenicity. The article highlights the need for large-scale and long-term clinical trials to better understand the true risk of stent thrombosis and to develop strategies to prevent it. It also explores potential future designs for DES, such as coatings that facilitate reendothelialization or combinations of prohealing substances with anti-restenotic drugs.