English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

The widespread adoption of balloon expandable coronary stents in the 1990s brought about a significant improvement in the results of percutaneous coronary intervention (PCI). There was not only a reduction in the number of patients requiring emergency coronary artery bypass graft (CABG) but also a reduction in the occurrence of clinically significant restenosis within the treated artery and thus the need for target vessel revascularisation (TVR).1,2 However, it soon became apparent that in certain patient types, and some complex coronary artery lesion subsets, restenosis related to neointimal proliferation caused by the endothelial injury resulting from stent implantation remained a significant problem. The advent of drug-eluting stents (DES), metal stents coated with a polymer and a drug aimed at reducing neointimal proliferation, resulted in further significant reductions in the rates of restenosis. This led to a rapid adoption of DES in the percutaneous treatment of coronary artery disease (CAD). By the end of 2004 DES were used in up to 80% of PCIs in the USA. Despite clinical evidence supporting the benefit of DES, longer follow-up studies have raised important questions about the safety and efficacy of DES in routine practice. Regardless of the clear improvement in the rates of restenosis in patients who receive DES in randomised controlled trials (RCT), the outcome data from ‘real-world’ registry collections of DES usage have been less impressive. Data have suggested no survival benefit between patients treated with bare metal stent (BMS) or DES.3 There have been numerous reports of abrupt stent occlusion due to stent thrombosis,4,5 and the ideal antiplatelet combination to optimise outcomes for PCI but minimise the risk of significant haemorrhage is yet to be established. This review will discuss the role of DES in reducing in-stent restenosis, the risks of stent thrombosis and the risks and benefits of long-term dual antiplatelet therapy (DAPT).

Update on drug-eluting stents: as good as it gets?