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Drug eluting stents (DES) permit controlled release of antiproliferative agents from durable polymer coatings and are recognised as a major innovation in the treatment of coronary artery disease.1 DES use has significantly improved clinical outcomes as compared with bare metal stents (BMS), primarily through a notable reduction in the risk of repeat revascularisation. However, the potent anti-restenotic effect of early generation DES—namely Cypher sirolimus eluting stents (SES) and Taxus paclitaxel eluting stents (PES)—came at the expense of delayed arterial healing of the stented coronary segment, characterised by chronic inflammation at the stented site with uncovered stent struts, coronary evaginations and positive vessel remodelling, fibrin deposition, and neoatherosclerosis.2 ,3 This pathological process has been proposed as a mechanism of the higher risk of late thrombotic events—specifically very late stent thrombosis—after implantation of early generation Cypher SES and Taxus PES.2
The introduction of newer generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, has improved upon the safety profile of early generation DES by significantly reducing the risk of stent thrombosis during the long term.4 ,5 It is noteworthy that this has not compromised their effectiveness, which has been further improved by the use of newer generation DES, with a significant reduction in the risk of target lesion revascularisation (TLR) compared with the early generation DES.5 ,6 Accordingly, newer generation DES—including durable polymer based Xience (Abbot Vascular, California, USA) and Promus (Boston Scientific, California, USA) everolimus eluting stents (EES), Resolute zotarolimus eluting stents (ZES) (Medtronic, California, USA), as well as biodegradable polymer based Biomatrix (Biosensors, Switzerland) and Nobori (Terumo, Japan) biolimus eluting stents, and Yukon Choice PC SES (Translumina, Germany)—have become the standard of care in all patient and lesion subsets with excellent long term results. …
Contributors GGS drafted the first version of the manuscript that was revised critically for important intellectual content by SW and MT. All three authors have approved the final version of the manuscript.
Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. SW has received research contracts to the institution from Abbott, Boston Scientific, Biosensors, Cordis, and Medtronic. The other authors have no competing interests.
Provenance and peer review Commissioned; internally peer reviewed.