Title: Are drug-eluting stents a panacea for patients with coronary heart disease?
Abstract: In patients with atherosclerotic coronary heart disease, dilation of the narrowed coronary artery with a catheter-borne balloon followed by a metal wire-mesh tube, called a stent, to scaffold the vessel segment has been the treatment of choice for well over a decade. This mechanical remedy usually re-establishes coronary blood flow, but does so at the cost of severe vessel wall injury. As with any biological system, the vessel wall responds to injury with a wound healing process including proliferation and migration of smooth-muscle cells to form a neointimal layer covering the stent struts. However, proliferative growth of smooth-muscle cells and the secretion of extracellular matrix can cause neointimal hyperplasia extending through the stent struts into the vessel lumen to obstruct coronary blood flow again. 1 Farb A Sangiorgi G Carter AJ et al. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999; 99: 44-52 Crossref PubMed Scopus (809) Google Scholar Stent restenosis—a lumen re-narrowing of at least 50%—usually occurs within 6–9 months of stent placement and can affect up to 60% of patients. It is mediated by a variety of factors, such as the calibre of the diseased coronary vessel, the location and extent of the lesion, and the presence or absence of diabetes mellitus. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stentsSirolimus-eluting and polymeric paclitaxel-eluting stents are effective at decreasing rates of angiographic restenosis and major adverse cardiac events compared with BMS. However, there is no evidence that they affect mortality or myocardial-infarction rates. They also appear to be safe in the short to medium term, although definitive conclusions are not possible. Larger studies with longer follow-up are needed to define better the role of these new devices. Full-Text PDF
Publication Year: 2004
Publication Date: 2004-08-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 7
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