Update on drug-eluting stents: as good as it gets?
نویسندگان
چکیده
The widespread adoption of balloon expandable coronary stents in the 1990s brought about a significant improvement in the results of percutaneous coronary intervention (PCI). There was not only a reduction in the number of patients requiring emergency coronary artery bypass graft (CABG) but also a reduction in the occurrence of clinically significant restenosis within the treated artery and thus the need for target vessel revascularisation (TVR).1,2 However, it soon became apparent that in certain patient types, and some complex coronary artery lesion subsets, restenosis related to neointimal proliferation caused by the endothelial injury resulting from stent implantation remained a significant problem. The advent of drug-eluting stents (DES), metal stents coated with a polymer and a drug aimed at reducing neointimal proliferation, resulted in further significant reductions in the rates of restenosis. This led to a rapid adoption of DES in the percutaneous treatment of coronary artery disease (CAD). By the end of 2004 DES were used in up to 80% of PCIs in the USA. Despite clinical evidence supporting the benefit of DES, longer follow-up studies have raised important questions about the safety and efficacy of DES in routine practice. Regardless of the clear improvement in the rates of restenosis in patients who receive DES in randomised controlled trials (RCT), the outcome data from ‘real-world’ registry collections of DES usage have been less impressive. Data have suggested no survival benefit between patients treated with bare metal stent (BMS) or DES.3 There have been numerous reports of abrupt stent occlusion due to stent thrombosis,4,5 and the ideal antiplatelet combination to optimise outcomes for PCI but minimise the risk of significant haemorrhage is yet to be established. This review will discuss the role of DES in reducing in-stent restenosis, the risks of stent thrombosis and the risks and benefits of long-term dual antiplatelet therapy (DAPT).
منابع مشابه
An advection-diffusion multi-layer porous model for stent drug delivery in coronary arteries
Arterial drug concentration distribution determines local toxicity. The safety issues dealt with Drug-Eluting Stents (DESs) reveal the needs for investigation about the effective factors contributing to fluctuations in arterial drug uptake. The current study focused on the importance of hypertension as an important and controversial risk factor among researchers on the efficacy of Heparin-Eluti...
متن کاملProgress in treatment by percutaneous coronary intervention: the stent of the future.
First generation drug-eluting stents have considerably reduced in-stent restenosis and broadened the applications of percutaneous coronary interventions for the treatment of coronary artery disease. The polymer is an integral part of drug-eluting stents in that, it controls the release of an antiproliferative drug. The main safety concern of first generation drug-eluting stents with permanent p...
متن کاملEverolimus-eluting stents: update on current clinical studies
Everolimus-eluting stents (EES) have become the most commonly implanted coronary stents worldwide. This review describes and analyzes the clinical data supporting the use of EES, focusing primarily on published, randomized, controlled trials. Everolimus-eluting stents have been shown to have less restenosis, stent thrombosis, and periprocedural myocardial infarction compared with earlier genera...
متن کاملDrug-eluting stents in preclinical studies: updated consensus recommendations for preclinical evaluation.
Coronary drug-eluting stents are commonplace in clinical practice with acceptable safety and efficacy. Preclinical evaluation of novel drug-eluting stent technologies has great importance for understanding safety and possibly efficacy of these technologies, and well-defined preclinical testing methods clearly benefit multiple communities within the developmental, testing, and clinical evaluatio...
متن کاملSpecial Report Drug-Eluting Stents in Preclinical Studies Updated Consensus Recommendations for Preclinical Evaluation
Coronary drug-eluting stents are commonplace in clinical practice with acceptable safety and efficacy. Preclinical evaluation of novel drug-eluting stent technologies has great importance for understanding safety and possibly efficacy of these technologies, and well-defined preclinical testing methods clearly benefit multiple communities within the developmental, testing, and clinical evaluatio...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Clinical medicine
دوره 7 4 شماره
صفحات -
تاریخ انتشار 2007