title: Stent thrombosis with drug-eluting stents: is the paradigm shifting?
abstract: First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Della Riva
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.affiliation: Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications
keywords: ARC; Academic Research Consortium; BMS; C10/C19/PVP polymer-based slow-release zotarolimus-eluting stent(s); CoCr-EES; DAPT; DES; FDA; Food and Drug Administration; MI; PC-ZES; PCI; PES; PtCr-EES; RCTs; Re-ZES; SES; ST; bare-metal stent(s); cobalt-chromium everolimus-eluting stent(s); drug-eluting stent(s); dual antiplatelet therapy; myocardial infarction; paclitaxel-eluting stent(s); percutaneous coronary intervention; phosphorylcholine polymer-based fast-release zotarolimus-eluting stent(s); platinum-chromium everolimus-eluting stent(s); randomized controlled trials; sirolimus-eluting stent(s); stent thrombosis; stent thrombosis