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Published on: March 3, 2023
Drug-eluting stents and vulnerable plaque
Mehmet Cilingiroglu1, Faisal Khan
1University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267, USA. mcilingiroglu@yahoo.com
Insights
Early intervention with drug-eluting stents may prevent acute coronary syndromes (ACS) caused by vulnerable plaque in mildly obstructive coronary lesions. This approach could reduce mortality from this leading cause of death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Acute coronary syndromes (ACS) are the leading global cause of mortality.
- ACS often result from vulnerable plaque rupture and thrombus formation in coronary arteries.
- Vulnerable plaques are frequently found in mildly obstructive lesions (<50% stenosis).
Purpose of the Study:
- To review the potential for early treatment of mildly obstructive coronary lesions.
- To evaluate the use of drug-eluting stents (DES) for preventing ACS.
- To assess the long-term efficacy of DES in managing these lesions.
Main Methods:
- Review of existing data on ACS, vulnerable plaque, and coronary lesion severity.
- Analysis of studies involving patients with ACS and prior coronary angiograms.
- Evaluation of the impact of percutaneous coronary interventions (PCI) and DES on restenosis and long-term outcomes.
Main Results:
- Vulnerable plaques leading to ACS are often associated with moderate, not severe, coronary stenosis.
- Percutaneous coronary intervention (PCI) for mildly obstructive lesions faces restenosis challenges.
- Drug-eluting stents (DES) have significantly reduced in-stent restenosis, improving long-term outcomes.
Conclusions:
- Early treatment of mildly obstructive coronary lesions with DES may prevent ACS.
- DES offer improved long-term efficacy compared to traditional PCI for these lesions.
- Further data is needed to confirm the preventative role of early DES intervention in ACS.
Abstract:
Coronary artery disease with acute coronary syndromes (ACS) is the leading cause of death worldwide in both men and women. ACS mostly occur as a result of rupture of "vulnerable plaque" with a superimposed thrombus formation, which ultimately leads to distal cessation of blood flow. Vulnerable plaque mostly occurs in mildly obstructive coronary lesions rather than severely stenosed (< 50%) lesions. Support for this conclusion comes from studies of patients with ACS who had a recent prior coronary angiogram; the artery involved in the subsequent ACS was usually only moderately diseased. Whether early treatment of these mildly obstructive lesions with percutaneous coronary interventions may lead to prevention of this deadly malady remains unknown. The long-term efficacy of percutaneous coronary intervention for mildly obstructive coronary narrowing is limited by the occurrence of restenosis, which limits the applicability of this therapy for these lesions. However, use of drug-eluting stents has significantly reduced the incidence of in-stent restenosis, yielding much better long-term outcomes. This article reviews the available data for possible early treatment of mildly obstructive coronary lesions with drug-eluting stents for prevention of ACS.
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