Drug-eluting stents for in-stent restenosis and acute myocardial infarction: present data from nonrandomized studies.
In-stent restenosis (ISR) remains the "Achilles' heel" of percutaneous stent angioplasty treatment of patients with atherosclerotic disease of the coronary arteries. Recently, drug-eluting stents (DES) have ushered in a revolution in the treatment of these patients, yet, to date, their efficacy and safety have been demonstrated primarily for native de novo coronary lesions. For ISR, intracoronary brachytherapy using beta- or gamma-radiation is considered the standard of care. Nevertheless, DES are used for ISR lesions in clinical practice. This review outlines the few results currently available from small observational studies and larger registries. The designs of two ongoing randomized trials evaluating the sirolimus-eluting and the paclitaxel-eluting stent versus brachytherapy in patients with ISR lesions are also presented. Patients with acute myocardial infarction (AMI) have mostly been investigated in the context of small, uncontrolled studies and registries. The incomplete evidence to date is that implantation of sirolimus-eluting stents in patients with AMI is safe and effective.
Schofer
Joachim
J
Center for Cardiology and Vascular Intervention, Hamburg, Germany. schofer@center-for-cardiology.de
Bode
Christoph
C
Silber
Sigmund
S
D000287:Administration, Topical; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000009:adverse effects; D001918:Brachytherapy; D002986:Clinical Trials as Topic; D020099:Coated Materials, Biocompatible; D023903:Coronary Restenosis / Q000517:prevention & control*; D003331:Coronary Vessels / Q000187:drug effects; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D015607:Stents; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D020099:Coated Materials, Biocompatible; D017239:Paclitaxel; D020123:Sirolimus