Percutaneous coronary intervention in the drug-eluting stent era

Abstract

Since the development of coronary angioplasty in the late 1970s, there has been a series of technical advancements that have improved the outcome of the procedure. Clearly, the great advance was to move from balloon angioplasty to intracoronary stenting. In addition to largely eliminating abrupt vessel closure and the need for emergency bypass surgery, stents have also led to substantial reductions in both angiographic and clinical restenosis compared with balloon angioplasty alone.
Among the various strategies explored, the development of drug-eluting stents has been particularly promising. Stents coated with sirolimus effectively prevented the development of neointimal proliferation and injured-induced arterial intimal thickening in preclinical studies and that of in-stent restenosis in human pilot studies. In randomized trials comparing sirolimus-eluting with conventional bare-metal stents, very low rates of in-stent restenosis were observed at 6 to 8 months of follow-up in the groups treated with drug-eluting stents. The either lack or sustained suppression of the neointimal proliferation was comfirmed by angiographic, intravascular ultrasound, and angioscopic (unpublished data) follow-up studies. Furthermore, the remarkable angiographically documented results were corroborated by very low rates of major adverse cardiac events at 1 year. Recently, the remarkable safety and efficacy of sirolimus-eluting stents were confirmed clinically up to 3 years after device implantation in the “late follow-up study from RAVEL, 2005”.