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Targeting drug-eluting stents to lesions at high risk of restenosis: a flawed approach?
  1. A K Siotia,
  2. A C Morton,
  3. S Mofidi,
  4. C Wales,
  5. C Newman,
  6. J Gunn
  1. Department of Cardiology, Northern General Hospital, Sheffield S5 7AU, UK
  1. Correspondence to:
    Dr J Gunn
    Cardiovascular Research Unit, University of Sheffield, Clinical Sciences Centre, Northern General Hospital, Sheffield S5 7AU, UK; J.Gunn{at}sheffield.ac.uk

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Drug eluting stents (DES) reduce the risk of restenosis as compared to bare metal stents (BMS).1 The high cost of these stents, however, makes their use in all patients undergoing percutaneous coronary intervention (PCI) problematic. In this journal 3 years ago we argued for a policy of selective implantation of DES, restricting their use to arteries of small calibre requiring a long stent, with some extra allowance for patients with diabetes.2 We recommended DES for all lesions if they needed a 2.5 or 2.75 mm stent ⩾12 mm long or a 3 mm stent ⩾16 mm long. For diabetic patients, in addition, a DES was recommended for stent sizes 2.5×8 mm, 3×12 mm and 3.5×⩾20 mm. For all other stent sizes, BMS were appropriate. These recommendations were similar in principle to the NICE guidelines.3 We estimated that the introduction of this policy would imply DES implantation in about 30% of lesions and would reduce the clinical restenosis rate in our institution by 33%.2

The aim of this study was to test the hypothesis that a policy of selectively targeted implantation of DES would lead to a significant reduction in our overall clinical restenosis rate.

METHODS

DES were available to us from July 2003 onwards. In the preceding …

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