Understanding the drug-eluting stent trials.
The advent of intravascular stenting dramatically reduced the incidence of restenosis among patients undergoing percutaneous transluminal coronary angioplasty. However, a substantial percentage of patients, particularly those with risk factors such as diabetes mellitus or complicated lesions, remain at risk for restenosis. Drug-eluting stents overcome this problem by releasing bioactive agents from a polymeric coating directly into the vessel wall, inhibiting the cellular mechanisms of restenosis while avoiding systemic toxicity. Recent data indicate that local targeting of the proliferative process with drug-eluting stents dramatically reduces the risk for restenosis, even among high-risk patients. A range of bioactive coatings are currently available or in late clinical trials. Both sirolimus- and paclitaxel-eluting stents have demonstrated efficacy in a broad range of patient types; early data from clinical trials of second-generation stent coatings, such as everolimus and ABT-578 (zotarolimus), suggest that these agents are also effective in preventing restenosis. This article reviews the pathophysiology of in-stent restenosis and surveys recent key clinical trials of drug-eluting stents.
Coolong
Alanna
A
Division of Cardiology, Brigham and Women's Hospital (a teaching affiliate of Harvard Medical School), Boston, Massachusetts, USA.
Kuntz
Richard E
RE
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000503:physiopathology / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000601:surgery*; D016503:Drug Delivery Systems; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage
D002317:Cardiovascular Agents; D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus