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[Radioactive stents: problems and potential solutions]
1Abteilung für Kardiologie und Angiologie, Medizinische Universitätsklinik III, Freiburg/Br. hehrlein@med1.ukl.uni-freiburg.de
Background:
The implantation of radioactive stents was the first procedure of a coronary brachytherapy in Europe examined in multicenter clinical trials.
Problems Of Radioactive Stents:
After more than 400 patients with radioactive stents were analyzed, it became clear that overall restenosis rates were not reduced. A new phenomenon called the "edge effect" or "candy-wrapper" effect was discovered, which later was also described for catheter-based brachytherapy. Currently, the implantation of radioactive stents for the prevention of restenosis cannot be recommended.
Drug Eluting Stents:
Although technical improvements of radioactive stents are theoretically possible, novel drug coated stents may overcome any future research of stent-based radiotherapy. Drug eluting stents induce antiproliferative effects beyond the stent margins. Edge effects were not observed in preliminary trials. However, long-term results need to be awaited.