Prevention of restenosis by a novel drug-eluting stent system with a dose-adjustable, polymer-free, on-site stent coating.
OBJECTIVE
Drug-eluting stents (DES) represent a major advance in interventional cardiology. Along with the success shown, current DES also present limitations related to the presence of polymer-coating, fixed drug, and dose used. With the ISAR (Individualized Drug-Eluting Stent System to Abrogate Restenosis) project, a DES system has been developed that permits individualized choice of the drug and dose to use for the given patient. The objective of this prospective dose finding study was to assess the feasibility, safety, and efficacy of a polymer-free on-site stent coating with increasing rapamycin doses.


RESULTS
In this dose finding study, 602 patients were sequentially enrolled in four groups: microporous bare metal stent (BMS), DES stents coated with a 0.5, 1.0, and 2.0% rapamycin solution. The angiographic in-segment restenosis rate at follow-up angiography was the primary study endpoint. In-segment restenosis was significantly reduced from 25.9% with BMS to 18.9, 17.2, and 14.7% with 0.5, 1.0, and 2.0% rapamycin-eluting stents, respectively (P=0.024). Similarly, the need for target lesion revascularization at 1 year follow-up was reduced from 21.5% with BMS to 16.4, 12.6, and 8.8% with 0.5, 1.0, and 2.0% rapamycin-eluting stents, respectively (P=0.006).


CONCLUSIONS
The placement of polymer-free stents coated on-site with rapamycin is feasible and safe. Furthermore, a dose-dependent efficacy in restenosis prevention is achievable with this new DES concept.
Hausleiter
Jörg
J
Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany. hausleiter@dhm.mhn.de
Kastrati
Adnan
A
Wessely
Rainer
R
Dibra
Alban
A
Mehilli
Julinda
J
Schratzenstaller
Thomas
T
Graf
Isolde
I
Renke-Gluszko
Magdalena
M
Behnisch
Boris
B
Dirschinger
Josef
J
Wintermantel
Erich
E
Schömig
Albert
A
D000368:Aged; D023903:Coronary Restenosis / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004343:Drug Implants; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D011108:Polymers; D011446:Prospective Studies; D012044:Regression Analysis; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016896:Treatment Outcome
D004343:Drug Implants; D007166:Immunosuppressive Agents; D011108:Polymers; D020123:Sirolimus