Drug eluting stents in 2005

Abstract

Drug eluting stents appear to be here to stay and have undoubtedly improved the outcome following stenting. Sirolimus and paclitaxel have lived up to early promise with robust results in increasingly complex trial lesions and in worldwide registries. There is probably little to choose between them, although tissue response suppression favouring the Cypher stent may be balanced by deliverability favouring the TAXUS stent. Other drugs/programme are critical and interestingly while they may have theoretical and even clear practical advantages, are likely to end up being "equivalent" since the size of trial required to demonstrate small clinical benefits would likely require many thousands of patients and be uneconomic to run. Issues such as price and cost effectiveness will be important also and has led to oral rapamycin being reconsidered. Areas requiring scientific resolution include efficacy in complex lesions such as LMS and bifurcation. Finally, developments in stent platform, techniques, and enhanced operator skill need to be recognised as being important. DES will only improve the outcome of the lesions we can (safely) do.