Eluting Stents

Ranade, S.V. et al. Physical characterization of controlled release of pacUtaxel from the TAXUS Express 2 drug-eluting stent, J. Biomed. Mater. Res., 71 A, 625, 2004. 

At least 2 to 3 months for sirolimus-eluting stent placement. 

At least 6 months following paclitaxel-eluting stent placement. 

Administer for a minimum of 6 months in patients receiving a paclitaxel-eluting stent during PCI... 

For patients undergoing PCI and receiving stents, the recommended dose is 325 once daily for at least 30 days with bare metal stents, for 3 months with a sirolimus-eluting stent, and for 6 months with a paclitaxel-eluting stent, followed by 75 to 162 mg once daily thereafter. 

Angiolillo DJ, Sabata M, Alfonso F, Macaya C. Candy wrapper effect after drug-eluting stent implantation Deja vu or stumbling over the same stone again. Cath Cardiovasc Interv 2004 61 387-391. 

Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002 346 1773-1780. 

Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004 350 221-231. 

Fattori R, Piva T. Drug-eluting stents in vascular intervention. Lancet 2003 361 247-249. 

Schwartz RS, Edelman ER, Carter A, et al. Drug-eluting stents in preclinical studies recommended evaluation from a consensus group. Circulation 2002 106 1867-1873. 

Dobesh PP, Stacy ZA, Ansara AJ, Enders JM. Drug-eluting stents a mechanical and pharmacologic approach to coronary artery disease. Pharmacotherapy 2004 24 1554-1577. 

Gershlick A, Kandzari DE, Leon MB, Wijns W, Meredith IT, Fajadet J, Popma JJ, Fitzgerald PJ, Kuntz RE. (2007) Zotarolimus-eluting stents in patients with native coronary artery disease Clinical and angiographic outcomes in 1,317 patients. Am J Cardiol 100 45M-55M. 

Rapamycin (sirolimus), a macrolide antibiotic, has been used recently in organ transplantation for its potent immunosuppressive actions by inhibiting both cytokine mediated and growth factor mediated proliferation of smooth muscle cells and lymphocytes [55, 56]. In the RAVEL trial of non-acute single vessel lesions, the Sirolimus-eluting stent was compared to bare metal stent (BMS) in a 1 1 fashion [57]. One-year major adverse cardiovascular events and 6 month neointimal proliferation as assessed by late luminal loss (-0.01 0.33 mm in Sirolimus stent versus 0.80 0.53 mm in BMS) were improved. The Sirolimus-eluting stent thus virtually eliminated in-stent restenosis with no evidence of edge effect, dissection, or in-stent thrombosis. 

Fig. 5.6 Sub-group analysis of SIRIUS drug eluting stent versus standard bare metal stenting at 270 days Massachusetts Medical Society)...

While drug eluting stents effectively tackled the problem of stent restenosis, other issues have emerged in recent times. In 2003, the FDA issued a warning regarding cases of sub-acute thrombosis (SAT) with the CYPHER stent that resulted in some deaths. This... 

In 2006, however, focus shifted to another rare but potentially catastrophic event known as late stent thrombosis, which, in contrast to subacute thrombosis, occurs months to years after stent placement. It usually occurs before endothelialization is complete. For bare metal stents, this takes a few weeks. However, in drug eluting stents, this process of endotheliazation is delayed [68]. This complication... 

B re-MeUl Stent % Paditaxel-Eluting Stent % Relative Risk (9596 Cl) P Value... 

Fig. 5.7 TAXUS IV 9 month sub-group analysis of the Paditaxel eluting stent versus comparative bare metal stent ( 2004 Massachusetts Medical Society)...

Holmes DR Jr, Leon MB, Moses JW, Popma JJ, Cutlip D, Fitzgerald PI, Brown C, Fischell T, Wong SC, Midei M, Snead D, Kuntz RE. Analysis of 1-year clinical outcomes in the SIRIUS trial a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation. 2004 Feb 10 109(5) 634-40. 

Moses J, Leon M, Popma J, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003 349 1315-1323. 

Grube E, Silber S, Hauptmann KE, et al. Six and twelve-month results from a randomized, double blind tial on a slow-release Pachtaxel-eluting stent for de novo coronary lesion. Circulation 2003 107 38 2. 

Camenzind E. Do drug-eluting stent increase death ESC Congress News. Barcelona, Spain 2006. 

Wilham HM. Unanswered questions—drug-eluting stents and the risk of late thrombosis. N Engl I Med 2007 Mar 8 356(10) 981-984. 

Serruys PW, Daemen I. Are drug-eluting stents associated with a higher rate of late thrombosis than bare metal stents Late stent thrombosis a nuisance in both bare metal and drug-eluting stents. Circulation 2007 115 1433-1439. 

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