Clinical Data of Eluting Stents

Abstract

Stents were introduced into clinical practice in the late 1980s. Subsequently, the Belgian Netherlands STENT and the Stent Restenosis Study trials established the “stent era” in coronary revascularization (1,2), despite an subacute thrombosis (SAT) rate of 3.7%, and more vascular bleeding complications with stents vs balloon angioplasty. Major advances in stent technologies have occurred in the past decades. Stent design has been altered to afford more flexibility, higher radial strength, lower profile, and minimal metallic coverage. Efforts are now directed at coating a stent with single or multiple bioactive antirestenosis agents, which is delivered uniformly to the underlying tissue, namely drug-eluting stents (DES). Recent clinical data (Table 1), which will be discussed in this chapter, have demonstrated the potential of these new stent technologies to become the predominant revascularization strategy in the near future. The list of promising DES technologies is long. Many of these devices were supported by sound basic science data, but only a few have proven clinical feasibility (Table 1). Based on the mechanism of action of the biological compound and its target in the restenotic process, DES were grouped as immunosuppressive, antiproliferative, anti-inflammatory, antithrombotic, and prohealing. Some agents, such as sirolimus, may affect multiple targets in the restenotic process but will be discussed under a single category.