The Quest for the Perfect Stent for a Given Patient: Drug-Coated Stents for the Treatment of Coronary Disease.

S ince the initial case of plain old balloon angioplasty by Andreas Grüntzig in 1977, there has been tremendous advancement in the treatment of coronary artery disease. After balloons and bare-metal stents (BMS), the introduction of drugeluting stents (DES) in 2002 transformed the practice of percutaneous coronary intervention (PCI) by significantly reducing rates of restenosis and repeat revascularization caused by the excessive tissue proliferation seen after BMS (1). The safety concerns raised by the first-generation sirolimusand paclitaxel-eluting stents (PES) in regard to higher rates of late stent thrombosis (ST) and very late ST prompted changes to DES (2). The second-generation DES employed new stent designswith thinner struts, stronger materials such as cobalt or platinum-chromium with more biocompatible permanent polymers, and new antiproliferative drugs such as everolimus and zotarolimus, which further improved performance with lower rates of restenosis and late ST but still required long-term dual antiplatelet therapy (DAPT) (3). Other DES with bioresorbable polymers were also developed and significantly decreased the late ST phenomenon (4).