Drug-eluting stents: results, promises and problems.
In-stent restenosis is the major drawback of percutaneous coronary interventions, occurring in 10-40% of the patients. Recently, new stents have emerged which are loaded with anti-inflammatory, anti-migratory, anti-proliferative or pro-healing drugs. These drugs are supposed to inhibit inflammation and neointimal growth and subsequently in-stent restenosis. In this review article the results of human clinical studies investigating drug-eluting stents are discussed from a clinical point of view, focussing on the efficacy in the prevention of restenosis and their potential side effects. Both success and failure in the field of drug-eluting stents have been described. Successful devices are the sirolimus-eluting and the polymer-based paclitaxel-eluting stents. Potentially dangerous side effects of drug-eluting stents are adverse drug interactions, incomplete stent apposition and increased in-stent thrombosis rates. Demonstration of long-term efficacy is mandatory since in some animal studies a delayed healing has been observed. Currently, the successful drug-eluting stents are under investigation in all types of lesions. We conclude that the results with some drug-eluting stents are promising, but further evidence on long-term efficacy and safety, also in high-risk subgroups, is needed.
van der Hoeven
Barend L
BL
Department of Cardiology C5-P, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
Pires
Nuno M M
NM
Warda
Hazem M
HM
Oemrawsingh
Pranobe V
PV
van Vlijmen
Bart J M
BJ
Quax
Paul H A
PH
Schalij
Martin J
MJ
van der Wall
Ernst E
EE
Jukema
J Wouter
JW
D023903:Coronary Restenosis / Q000517:prevention & control*; D016503:Drug Delivery Systems; D006801:Humans; D015607:Stents