Drug-eluting stents: caution and concerns for long-term outcome.
Recent publications on drug-eluting stents (DES) report a significant reduction in restenosis rates as compared to bare metal stents in patients mostly with single vessel disease. We have recently observed however, late stent thrombosis following CYPHER DES implantation. The patient developed a hypersensitivity reaction around stent struts limited to the polymer with aneurysmal dilatation and extensive inflammation of the arterial wall in the absence of vascular healing. This incidence promotes a cautionary view and perhaps supports the use of DES only in high-risk patients.
Virmani
Renu
R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC, USA. virmani@afip.osd.mil
Farb
Andrew
A
Guagliumi
Giulio
G
Kolodgie
Frank D
FD
D000818:Animals; D023903:Coronary Restenosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D018795:Device Approval; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects*; D011108:Polymers / Q000009:adverse effects*; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology; D014481:United States; D014945:Wound Healing / Q000276:immunology
D007166:Immunosuppressive Agents; D011108:Polymers; D017239:Paclitaxel; D020123:Sirolimus