Drug-eluting stent

Keywords Coronary stent Bare metal stent Drug-eluting stent Restenosis Late thrombosis Bioabsorbable stent Future generation stent... 

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. 

FIGURE 4.5 A 72-year-old man with medical history remarkable for hypertension and dyslipidemia presented with posterior circulation infarct (a). CTA and posterior circulation angiography (left vertebral artery injection) performed demonstrated severe mid-basilar artery stenosis (b and c). Left vertebral artery injection demonstrated near-complete reversal of the stenosis after a drug-eluting balloon expandable stent (Cypher, Cordis Johnson Johnson) was deployed (d). 

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. 

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. 

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... 

McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004 364 1519-1521. 

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. 

Mauri L, Hsieh WH, Massaro IM, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 2007 356 1020-1029. 

Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007 297 159-168. 

To provide optimal immunosuppressant effects, sirolimus is typically combined with glucocorticoids or other immunosuppressants. Sirolimus exerts a number of other beneficial effects, including the ability to inhibit smooth muscle proliferation in blood vessel walls. For this reason, sirolimus is sometimes incorporated into drug-eluting stents that is, a supportive tubular structure (stent) is placed in the lumen of a partially occluded artery, and the drug is released slowly from the stent to help reduce vessel occlusion.64... 

Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans Delayed healing and late thrombotic risk. J Am Coll Cardiol 2006 48 193-202. 

Drug-eluting stents, brachytherapy, and peripheral intervention... 

Several smaller studies have also explored the use of bivalirudin with drug-eluting stents, brachytherapy, and in peripheral intervention (40-42). Although lacking optimal comparative design, these studies appear to indicate a safety and efficacy profile comparable to that observed in the randomized clinical trials. 

Dangas G, Lasic Z, Mehran R, et al. Effectiveness of the concomitant use of bivalirudin and drug-eluting stents (from the prospective, multicenter BivAlirudin and Drug-Eluting STents [ADEST] study). AmJ Cardiol 2005 96 659-663. 

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