title: Therapies targeting inflammation after stent implantation.
abstract: Since the introduction of coronary vessel scaffold by metallic stent, percutaneous coronary intervention has become widely performed all over the world. Although drug-eluting stent technology has further decrease the incidence of in-stent restenosis, there still remaining issues related to stent implantation. Vessel inflammation is one of the causes that may be related to stent restenosis as well as stent thrombosis. Therefore, systemic therapies targeting inflammation emerged as adjunctive pharmacological intervention to improve outcome. Statins, corticosteroids, antiplatelets, and immunosuppresive or anti-cancer drugs are reported to favorably impact outcome after bare-metal stent implantation. In type 2 diabetic patients, pioglitazone may be the most promising drug that can lower neointimal proliferation and, as a result, lower incidence of restenosis and target lesion revascularization. On the other hand, several new stent platforms that might decrease inflammatory response after drug-eluting stent implantation have been introduced. Because durable polymer used in the first generation drug-eluting stents are recognized to be responsible for unfavorable vessel response, biocompatible or bioabsorbable polymer has been introduce and already used clinically. Furthermore, polymer-free drug-eluting stent and bioresorbable scaffold are under investigation. Although vessel inflammation may be reduced by using these new drug-eluting stents or scaffold, long-term impact needs to be investigated further.
authors.affiliation: Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan. hokura@fides.dti.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takagi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D001672:Biocompatible Materials / Q000737:chemistry; D023903:Coronary Restenosis / Q000209:etiology / Q000473:pathology; D023921:Coronary Stenosis; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011108:Polymers / Q000737:chemistry; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; D011108:Polymers