Drug-eluting stents. The third revolution in percutaneous coronary intervention.
Local stent-based drug delivery (drug-eluting stent - DES) is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary interventions. A number of DESs have been developed using different carrier stents, different kind of coatings, and different drugs. However, to date only two polymer-coated DESs (the Cypher sirolimus-eluting stent from Cordis, Johnson & Johnson, Miami Lake, FL, USA; and the Taxus paclitaxel-eluting stent, Boston Scientific, Natick, MA, USA) have become commercially available after a number of randomized trials showed their ability to reduce late luminal loss, binary restenosis and the need for repeat revascularization when compared to bare metal stents. This review describes the general concept of DES and summarizes the results of the principal clinical trials on DESs, both approved for clinical use or under development. For the marketed stents, we also report the results of the first clinical evaluations in real life and a few insights into the most controversial issues.
Saia
Francesco
F
Department of Interventional Cardiology, Erasmus Medical Center Thoraxcenter, Rotterdam, The Netherlands. francescosaia@hotmail.com
Marzocchi
Antonio
A
Serruys
Patrick W
PW
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D020099:Coated Materials, Biocompatible; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D016503:Drug Delivery Systems / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D011379:Prognosis; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D017239:Paclitaxel; D020123:Sirolimus