[PCI: state of the art]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials

Background:

• Restenosis remains a significant challenge in percutaneous coronary intervention (PCI).
• Drug-eluting stents (DES) have emerged as a solution to mitigate restenosis.
• Previous trials showed varying restenosis rates, with some edge restenosis observed.

Purpose of the Study:

• To evaluate the effectiveness of drug-eluting stents (DES) in reducing restenosis rates.
• To explore the expanded indications for PCI with DES.
• To assess the safety and efficacy of DES in different patient populations and lesion types.

Main Methods:

• Review of randomized controlled trials (RAVEL, SIRIUS) and observational registry data (j-Cypher).
• Analysis of restenosis rates in simple and complex coronary lesions.
• Evaluation of stent thrombosis incidence and antiplatelet therapy strategies.

Main Results:

• DES demonstrated a drastic decrease in restenosis rates, leading to expanded PCI indications.
• Edge restenosis rates were reduced with newer stent designs.
• The j-Cypher trial indicated safety of DES with ticlopidine-based antiplatelet therapy in Japan.

Conclusions:

• DES have revolutionized PCI by effectively managing restenosis, enabling treatment of complex lesions.
• While DES show promise, continued monitoring for stent thrombosis and long-term outcomes is crucial.
• Further real-world data from ongoing trials are necessary to fully establish the long-term benefits of DES.