Drug-Eluting Stents: Risks and Benefits
Keywords:
Coronary artery disease, Randomized controlled trials, Stent thrombosisAbstract
Cardiologists have been discussing emerging evidence that drug eluting stents (DES), as effective tools in coronary artery diseases. DES may inhibit the growth of the normal tissue that, typically, will eventually coat bare metal stents. This normal tissue inhibits blood clotting on the stent. A stent is a latticed, metal scaffold that is placed within the coronary artery to keep the vessel open. Drugeluting stents are coated in a drug that reduces the likelihood of the artery from becoming narrow again after surgery. Once implanted into the artery, the drug is slowly absorbed into the tissues surrounding the stent. Heart attacks are the major causes of death and disability and are the result of inadequate blood flow to the heart caused by blocked arteries. Despite the large amount of favorable benefits ands long-term data on the use of drug-eluting stents from randomized controlled trials, meta-analyses and observational studies, the long-term safety of drug-eluting stents, especially regarding late and very late stent thrombosis, remains a major concern. This article mainly deals with benefits and risk factors of drug eluting stents.
References
Moses JW, Leon MB, Popma, JJ, Fitzgerald PJ,
Holmes DR, O'Shaughnessy C, Caputo RP,
Kereiakes DJ. et al. Sirolimus-eluting stents
versus standard stents in patients with
stenosis in a native coronary artery. New
England Journal of Medicine.
;349:1315-23.
Stone GW, Ellis SG, Cox DA, Hermiller J,
O'Shaughnessy C, Mann JT, Turco M,
Caputo R. et al. One-year clinical results
with the slow-release, polymer-based,
paclitaxel-eluting TAXUS stent: the
TAXUS-IV trial. Circulation.
;109:1942-7.
Grüntzig AR, Senning A, Siegenthaler WE.
Non operative dilatation of coronary-artery
stenosis: per cutaneous transluminal
coronary angioplasty. New England Journal
of Medicine. 1979;301:61–68.
Baim DS. Percutaneous Coronary
Revascularization. in Dennis L. Kasper,
Anthony S. Fauci, Dan L. Longo, Eugene
Braunwald, Stephen L. Hauser, & J. Larry
Jameson. Harrison's Principles of Internal
Medicine (16th ed.). New York: McGrawHill. 2005; pp. 1459-1462.
Serruys PW, Kutryk MJ, Ong AT. Coronary
artery stents. N. Engl. J. Med. 2006;354 (5):
–95.
Morice MC, Serruys PW, Barragan P, Bode
C, Van Es GA, Stoll HP, Snead D, Mauri L.
et al. Long-term clinical outcomes with
sirolimus-eluting coronary stents: five-year
results of the Ravel trial. JACC.
;50:1299–304.
Peels JO, Hautvast RW, de Swart JB. et al.
Percutaneous coronary intervention without
on site surgical back-up; two-years registry
of a large dutch community hospital. Int. J.
Cardiol. 2008;132: 59.
Virmani R, Guagliumi G, Farb A,
Musumeci G, Grieco N, Motta T, Mihalcsik
L, Tespili M, Valsecchi O, Kolodgie FD.
Localized hypersensitivity and late coronary
thrombosis secondary to a sirolimus-eluting
stent: should we be cautious? Circulation.
;109:701-5.
Hwang CW, Levin AD, Jonas M, Li PH,
Edelman ER. Thrombosis modulates arterial
drug distribution for drug-eluting stents.
Circulation. 2005;111:1619–26.
Iakovou I, Schmidt T, Bonizzoni E, et al.
Incidence, predictors, and outcome of
thrombosis after successful implantation of
drug-eluting stents. JAMA. 2005; 293 (17):
–30
Cook S, Ladich E, Nakazawa G, Eshtehardi P,
Neidhart M, Vogel R, Togni M, Wenaweser P,
Billinger M, Seiler C, Gay S, Meier B, Pichler
WJ, Jüni P, Virmani R, Windecker S.
Correlation of intravascular ultrasound findings
with histopathological analysis of thrombus
aspirates in patients with very late drug-eluting
stent thrombosis. Circulation. 2009;120:391-99
Daemen J, Serruys PW. Drug-eluting stent
update 2007: part II: Unsettled issues.
Circulation. 2007;116:961–8.
Bavry AA, Kumbhani DJ, Helton TJ, Borek PP,
Mood GR, Bhatt DL. Late thrombosis of drugeluting stents: a meta-analysis of randomized
clinical trials. Am. J. Med. 2006;119:1056–61.
MedScape.com
www.nice.org.uk/aboutguidance
Sabate M, Jimenez-Quevedo P, Angiolillo DJ,
et al. Randomized comparison of sirolimuseluting stent versus standard stent for
percutaneous coronary revascularization in
diabetic patients: the diabetes and sirolimuseluting stent (DIABETES) trial Circulation.
;112:2175-2183.
Brar SS, Syros G, Dangas G. Angiology
Multivessel disease: percutaneous coronary
intervention for classic coronary artery bypass
grafting indications. 2008;59:83S-8S.
Fattori R, Piva T. Drug-eluting stents in
vascular intervention. The Lancet.
;361;247-9.
Tanabe K, Regar E, et al. Local drug delivery
using coated stents: new developments and
future perspectives. Current Pharmaceutical
Design. 2004;10:357-67.
