Interv Akut Kardiol. 2003;2(2):73-81

LOCAL DRUG DELIVERY STENTS IN THE PREVENTION OF RESTENOSIS

Jan Kováč

Kardiologická klinika Glenfieldské všeobecné nemocnice, Velká Británie

The usage of stents reduced the angiographic restenosis (ISR) down to 7–37 % in de novo lesions in randomised controlled trials. Clinical incidence of restenosis is still up to 40 % depending on lesion morphology and/or patient characteristics (eg diabetes mellitus).

ISR is related to neointimal proliferation due to smooth muscle cell accumulation in the proteoglycan matrix.

Local drug delivery is a very promising concept in the prevention of ISR. Among many drugs used in ISR prevention experiments, paclitaxel and rapamycin now have shown good efficiacy in large randomized trials, with significant ISR reduction up to 1 year and currently are marketed for this indication. The only drawback at the moment is their cost, significantly higher in comparison with conventional stents. Research in this field continues and there are number of further candidate drugs and modulators (NO) as well as new stent designs and materials and systemic drugs.

It is possible, that there will be specific drug used in specific indication (eg acute coronary syndrome). Problems to be solved are late adverse effects as wall as how to treat rare, but existent ISR post local drug delivery implant. Local drug delivery neverthless is a verz significant imporvement in the prevention of ISR.

Keywords: stent, restenosis, local drug delivery.

Published: December 31, 2003  Show citation