Drug-eluting stents: towards new endpoints.
Drug-eluting stents (DES) have significantly reduced the rates of in-stent restenosis (ISR). As previously observed with bare-metal stents (BMS), either patient's clinical characteristics and lesion morphology may influence the risk of recurrence even with DES. In this review we will focus on the most recent available data on clinical settings where DES efficacy on long-term outcomes are largely unknown. In particular, we report on very complex lesions (bifurcations, small vessels, chronic total occlusions, in-stent restenosis) myocardial infarction, multivessel disease, treatment of bypass graft and of unprotected left main disease. Several issues are still open on DES routinary use for these indications, mainly as far as stent thrombosis is concerned. Recent pathological studies show that DES are characterized by chronic inflammatory infiltrates and delayed endothelialization. Therefore, this effect could translate in a ''vulnerable period'' for thromboses longer than with BMS. Even though large meta-analysis have excluded higher rates of stent thrombosis with DES rather than with BMS, few cases of unusual very late stent thrombosis have been described, pointing out that this problem seems to be still unsolved. Although DES provide better angiographic outcomes in each clinical setting, further randomized studies are running to assess their safety and efficacy on currently off-label indications.
Presbitero
P
P
U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano-Milan, Italy. patrizia.presbitero@humanitas.it
Zavalloni
D
D
Rossi
M L
ML
Pagnotta
P
P
Belli
G
G
Gasparini
G L
GL
Corrada
E
E
Milone
F
F
D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000628:therapy; D016503:Drug Delivery Systems / Q000009:adverse effects; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D012042:Registries; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology