TY  - CHAP
M1  - Book, Section
TI  - Drug-Eluting Coronary Stents
A1  - Steinvil, Arie
A1  - Waksman, Ron
A2  - Samady, Habib
A2  - Fearon, William F.
A2  - Yeung, Alan C.
A2  - King III, Spencer B.
PY  - 2017
T2  - Interventional Cardiology, 2e
AB  - Several  major  leaps  in  technology  and  immense  research  and  development  have  led  to  the  current  wide  use  of  drug-eluting  stents  (DES).  Stents  were  initially  developed  to  reduce  the  high  rates  of  restenosis  and  acute  vessel  closure  following  balloon  angioplasty–induced  endothelial  cell  denudation  and  coronary  artery  medial  layer  tearing.1  The  first  bare  metal  stent  (BMS)  implantation  in  a  coronary  artery  was  reported  by  Sigwart  et  al2  in  1987,  and  the  first  randomized  trial  comparing  balloon  angioplasty  and  BMS  was  reported  by  Fischman  et  al3  in  1994.  As  compared  to  balloon  angioplasty,  BMS  implantation  was  associated  with  an  improved  rate  of  procedural  success,  a  lower  rate  of  angiographically  detected  restenosis,  similar  rates  of  clinical  events  after  6  months,  and  a  less  frequent  need  for  target  vessel  revascularization  (TVR).3  These  results  eventually  led  to  the  use  of  BMS  as  the  standard  of  care  for  the  treatment  of  de  novo  coronary  stenosis.  The  use  of  BMS,  however,  was  associated  with  a  high  incidence  of  in-stent  restenosis  (ISR)  mainly  due  to  intimal  hyperplasia.4  The  high  ISR  rates  in  BMS  eventually  led  to  the  idea  of  coating  the  BMS  with  antiproliferative  agents.  Therefore,  the  primary  purpose  of  DES  has  been  the  prevention  of  vessel  recoil,  negative  remodeling,  and  ISR.  First  introduced  in  2002,  first-generation  DES  have  been  shown  to  be  superior  to  BMS  with  respect  to  lower  rates  of  clinical  and  angiographic  restenosis  and  target  lesion  revascularizations  (TLR)  as  compared  to  BMS.5,6  However,  following  real-world  experience,  concerns  regarding  high  rates  of  late  stent  thrombosis  (ST)  have  emerged,7  leading  to  a  change  in  the  recommendations  for  dual  antiplatelet  therapy  following  DES  implantation.8  The  vast  research  and  development  leading  to  a  newer  generations  of  DES,  better  understanding  of  the  mechanisms  of  ST,  and  advances  in  technology,  technique,  adjunctive  pharmacology,  and  operator  experience  have  resulted  in  improved  outcomes  and  the  widespread  use  of  DES.  This  eventually  lead  to  the  fact  that  the  vast  majority  of  stents  being  implanted  during  percutaneous  coronary  intervention  (PCI)  in  the  United  States  are  DES9  as  well  as  to  the  wide  endorsement  for  the  use  of  these  stents  in  US  and  European  clinical  guidelines.10,11  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - accesscardiology.mhmedical.com/content.aspx?aid=1146598503
ER  -