Stent thrombosis with drug-eluting stents

Is the paradigm shifting?

Tullio Palmerini, Giuseppe Biondi-Zoccai, Diego Della Riva, Andrea Mariani, Philippe Genereux, Angelo Branzi, Gregg W. Stone

Research output: Contribution to journalReview article

85 Citations (Scopus)

Abstract

First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.

Original languageEnglish (US)
Pages (from-to)1915-1921
Number of pages7
JournalJournal of the American College of Cardiology
Volume62
Issue number21
DOIs
StatePublished - Jan 1 2013

Fingerprint

Drug-Eluting Stents
Stents
Thrombosis
Polymers
Chromium
Cobalt
Metals
Safety
Sirolimus
Percutaneous Coronary Intervention
Paclitaxel
Meta-Analysis
Hypersensitivity
Inflammation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, T., Biondi-Zoccai, G., Della Riva, D., Mariani, A., Genereux, P., Branzi, A., & Stone, G. W. (2013). Stent thrombosis with drug-eluting stents: Is the paradigm shifting? Journal of the American College of Cardiology, 62(21), 1915-1921. https://doi.org/10.1016/j.jacc.2013.08.725
Palmerini, Tullio ; Biondi-Zoccai, Giuseppe ; Della Riva, Diego ; Mariani, Andrea ; Genereux, Philippe ; Branzi, Angelo ; Stone, Gregg W. / Stent thrombosis with drug-eluting stents : Is the paradigm shifting?. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 21. pp. 1915-1921.
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abstract = "First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.",
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Palmerini, T, Biondi-Zoccai, G, Della Riva, D, Mariani, A, Genereux, P, Branzi, A & Stone, GW 2013, 'Stent thrombosis with drug-eluting stents: Is the paradigm shifting?', Journal of the American College of Cardiology, vol. 62, no. 21, pp. 1915-1921. https://doi.org/10.1016/j.jacc.2013.08.725

Stent thrombosis with drug-eluting stents : Is the paradigm shifting? / Palmerini, Tullio; Biondi-Zoccai, Giuseppe; Della Riva, Diego; Mariani, Andrea; Genereux, Philippe; Branzi, Angelo; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 62, No. 21, 01.01.2013, p. 1915-1921.

Research output: Contribution to journalReview article

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T1 - Stent thrombosis with drug-eluting stents

T2 - Is the paradigm shifting?

AU - Palmerini, Tullio

AU - Biondi-Zoccai, Giuseppe

AU - Della Riva, Diego

AU - Mariani, Andrea

AU - Genereux, Philippe

AU - Branzi, Angelo

AU - Stone, Gregg W.

PY - 2013/1/1

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AB - First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.

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