[Drug eluting stents: from evidence based medicine to clinical practice].
Drug eluting stents have been developed in order to reduce in-stent restenosis observed with a 20 to 40% rate in bare-stents. Neoinitimal smooth muscular cells proliferation have been characterized as the corner stone of in-stent restenosis. Consequently, many anti-mitotic and anti-inflammatory drugs have been evaluated in a new stent generation, so called coated stents or drug eluting stents. Three major components must be considered to evaluate the beneficial effects: the bare-stent, the drug, and the deliverance system, most usually a polymer. For the present, sirolimus eluting stent and paclitaxel eluting stent are available in the market with the european conformity label considering evidence based medicine established in randomized trials. Both stents have been shown to reduce in-stent restenosis incidence to less than 7%. Long-term follow-up still remain expected and would give answers to two safety queries: what is about the incidence of late stent thrombosis, what is about mal-apposition consequences in clinical feature. Utilization of drug eluting stent in clinical practice must considered materials with european conformity and must applied French society of cardiology guidelines restricting implantation to patients who meet high-risk restenosis criteria. Medicoeconomic approach must be considered beneficial at the present only in patients with high restenosis risk. Long-term antiplatelet regimen of aspirin and clopidogrel must be considered to avoid late stent thrombosis.
Philippe
F
F
Département de pathologie cardiaque, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France. francois.philippe@imm.fr
Dibie
A
A
Larrazet
F
F
Meziane
T
T
Folliguet
T
T
Laborde
E
E
D002986:Clinical Trials as Topic; D023903:Coronary Restenosis / Q000517:prevention & control*; D016503:Drug Delivery Systems; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D017239:Paclitaxel / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents / Q000191:economics; D016559:Tacrolimus / Q000627:therapeutic use; D062367:ortho-Aminobenzoates / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D062367:ortho-Aminobenzoates; C012293:tranilast; D017239:Paclitaxel; D020123:Sirolimus; D016559:Tacrolimus