Drug-eluting stents: from bench to bed.
The introduction of stents to clinical practice in 1987 was the major breakthrough in the field of percutaneous coronary intervention (PCI). The use of stenting has drastically improved the outcomes of traditional PCI. First stents were approved for bailout and treatment of dissections, reducing dramatically the need for emergent coronary artery bypass grafting (CABG) as a result of vessel closure during PCI. Later stents were proven to reduce the restenosis rate of PCI from 30%-40% with balloon angioplasty to 15%-20% with stents, primarily by eliminating elastic recoil and vascular remodeling as shown by intravascular ultrasound (IVUS) studies. These outcomes have led to a wide acceptance of stenting as the strategy of choice for more than 80% of all PCI procedures performed. The current review focuses on the following topics: (1) strategies in drug selection to reduce neointimal proliferation, (2) stent designs and polymer selection as a platform for drug-eluting stents, (3) review of major preclinical and clinical experimental work performed in the field, and (4) a discussion of the potential and limitations of the technology.
Waksman
Ron
R
Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA. ron.waksman@medstar.net
D000818:Animals; D020811:Biomedical Technology; D023903:Coronary Restenosis / Q000517:prevention & control*; D004195:Disease Models, Animal; D016503:Drug Delivery Systems; D004867:Equipment Design; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D066298:In Vitro Techniques; D015607:Stents; D013552:Swine