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Methotrexate eluting stents: to modify or cure?
  1. A C Morton,
  2. J Gunn
  1. Cardiovascular Research Group, University of Sheffield, Sheffield, UK
  1. Correspondence to:
    Dr Julian Gunn
    Cardiovascular Research Group, Clinical Sciences Building, Northern General Hospital, Sheffield S5 7AU, UK;

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Just as a single antibiotic cannot treat all infections, it may be that a variety of agents utilised in drug eluting stents will be necessary to treat restenosis

With the introduction of drug eluting stents (DES) into routine percutaneous coronary intervention (PCI), many consider the battle against restenosis won. A more realistic viewpoint, perhaps, is that these are merely the early engagements in what will eventually turn out to be a longer war. The evidence base for sirolimus and paclitaxel eluting stents is impressive, with target vessel revascularisation < 5% at nine months in selected patients and lesions.12 One area of uncertainty is whether these two agents alone are sufficient to treat the wide variety of lesions found in day-to-day practice; just as a single antibiotic cannot treat all infections, it may be that a variety of agents will be necessary to treat restenosis. Another question is whether there will be room to further lower the restenosis rate (ideally to zero) in the “real world” where complex coronary artery lesions (long, diffuse, calcific, etc) are the norm rather than the exception. Is there room for more troops on the restenosis “field of battle”?

In this issue of Heart, Huang and colleagues describe the effects of methotrexate contained in a new biological polymer coating (SAE) upon in-stent stenosis in a porcine model of coronary artery stent implantation.3


Methotrexate is a folate antagonist and is widely used in the treatment of proliferative diseases such as Crohn’s disease, cancer, rheumatoid arthritis, and psoriasis. Folates are essential for the synthesis of purine nucleotides and thymidylate that, in turn, are essential for DNA synthesis and cell division. In order to act as coenzymes, folates must be reduced to tetrahydrofolate. Methotrexate exerts its cytotoxic effects by inhibiting dihydrofolate reductase and depleting intracellular …

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