Drug-eluting stents: clinical perspectives on drug and design differences

Although the introduction of coronary stents has significantly improved the treatment of patients with coronary artery disease, restenosis, due to neointimal proliferation following stent deployment and associated with a return of ischemic symptoms, has remained a critical concern. Recent studies have shown that the use of drug-eluting stents to deliver antiproliferative agents directly to the vessel wall dramatically reduces the rate of restenosis. However, important differences exist among stent designs, drug-delivery vehicles, and choices of pharmacologic agents that can significantly affect the safety and efficacy of each device. Although engineers, vascular biologists, and clinicians all agree that clinical success of drug-eluting stents requires careful integration of the individual system components, the optimal combination remains to be determined.