Long-term Outcomes in Patients Undergoing Percutaneous Coronary Intervention with Drug-eluting Stents

Roberta Rossini; Giuseppe Musumeci; Alessandro Aprile; Orazio Valsecchi

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(1):49-61. 

In This Article

Five-year View

New antirestenosis drugs are currently being developed. They aspire to obtain better results by decreasing the drawbacks associated with current DES (delayed healing and late stent thrombosis) and increasing the success rate.[73]

Everolimus is synthesised from sirolimus, is currently used as immunosuppressant and is proven to have a better pharmacokinetic profile and bioavailability than sirolimus.[74] The new everolimus DES (Xience V™, Abbott, IL, USA) showed superiority over taxus in reducing in-stent restenosis and MACE.[75–77] The 3-year results for second-generation DES with everolimus were recentely presented by Greg Stone at the TCT 2009. Treatment with everolimus-eluting stent compared with paclitaxel-eluting stent resulted in significant reductions in target vessel failure, MACE and need for TLR.

Biolimus A9™ is a new high-lipophilic sirolimus analog that was specifically designed for stent applications. Biolimus is well tolerated and effective. Compared with sirolimus, it has a similar immunosuppressive activity, but is more rapidly absorbed by the vessel wall. The Nobori-1 and core trial demonstrated that biolimus DES were associated with a lower neointimal formation as compared with PES and SES.[78,79]

New stents with more biocompatible polymers (Endeavor® Resolute) and third-generation DES have successfully completed Phase III and are now available for clinical employment.[80] The current attempt in this new generation is to obviate vascular hypersensitivity with the employment of bioabsorbable or bioerodable polymer or the dismissal of the polymer itself. In order to reduce the risk of late and very-late stent thrombosis, DES with abluminally applied biodegradable polymers that leave a polymer-free BMS upon completed drug release have been tested.[81,82] In a pilot study, the NEVO, a stent based on reservoir technology, demonstrated promising results in terms of late lumen loss and MACEs compared with first-generation PES.

Recent studies evaluated mid-term results of endothelial progenitor cell-coating stents, which are able to sequester endothelial progenitor cells to the stent to promote the post-stenting vascular repair response.[83,84] This technology significantly promotes late regression of neointimal hyperplasia. Finally, new intracoronary imaging modalities, such as optical coherence tomography, might further improve stent deployment, thus reducing the rate of incomplete apposition and the risk of stent thrombosis.[85]

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