Appropriate use of drug-eluting stents: balancing the reduction in restenosis with the concern of late thrombosis

Anthony A. Bavry, Deepak L. Bhatt

Research output: Contribution to journalReview articlepeer-review

106 Scopus citations

Abstract

Restenosis is a serious occurrence that can lead not only to recurrent angina and repeat revascularisation but also to acute coronary syndromes. Drug-eluting stents revolutionised interventional cardiology owing to their pronounced ability to reduce restenosis compared with bare-metal stents. Attention has now shifted to safety of these devices because of evidence suggesting an association with late stent thrombosis. Findings of randomised clinical trials have not shown that drug-eluting stents result in excess mortality after 4-5 years of follow-up. Current recommendations are that individuals with a drug-eluting stent should receive at least 12 months of uninterrupted dual antiplatelet treatment; patients must understand the importance of this long-term regimen. Patients' assessment should focus on bleeding abnormalities, pre-existing disorders that need anticoagulation treatment, and possible future surgical procedures, since these factors could all contraindicate use of drug-eluting stents. Many people will do well with a bare-metal stent, whereas for individuals with a high likelihood of restenosis and late thrombosis, medical management or surgical revascularisation might be preferred options.

Original languageEnglish (US)
Pages (from-to)2134-2143
Number of pages10
JournalThe Lancet
Volume371
Issue number9630
DOIs
StatePublished - 2008
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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