The first-generation drug-eluting stents and coronary endothelial dysfunction
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Published on: May 14, 2013
Lakshmana K Pendyala1, Xinhua Yin, Jinsheng Li
1Department of Cardiology, University of Louisville, Louisville, Kentucky, USA.
Insights
First-generation drug-eluting stents (1st-gen DES) may cause long-term coronary artery dysfunction in non-stented areas. This review examines the clinical and pathological data on 1st-gen DES-associated vascular issues.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- First-generation drug-eluting stents (1st-gen DES) are widely used for coronary artery disease.
- Clinical data suggest 1st-gen DES may cause delayed vasomotor dysfunction in non-stented arterial segments up to 12 months post-implantation.
- This contrasts with bare-metal stent outcomes.
Purpose of the Study:
- To systematically review clinical, pathophysiological, and histopathological data on 1st-gen DES-associated vascular endothelial dysfunction.
- To explore the underlying mechanisms, including delayed healing and impaired re-endothelialization.
- To discuss newer DES generations and endothelial-friendly technologies.
Main Methods:
- Systematic literature review of clinical studies.
- Analysis of pathophysiological mechanisms.
- Review of histopathological findings.
- Evaluation of data on newer DES and emerging technologies.
Main Results:
- 1st-gen DES implantation is associated with coronary artery vasomotor dysfunction at non-stented segments.
- Delayed arterial healing and poor re-endothelialization are implicated mechanisms.
- Understanding long-term safety is crucial due to widespread DES use.
Conclusions:
- Further research into 1st-gen DES safety and mechanisms of vascular dysfunction is warranted.
- Newer DES generations and endothelial-friendly technologies may offer improved safety profiles.
- Comprehensive understanding of DES impact on vascular health is essential for patient outcomes.
Abstract:
Recently, a growing body of clinical data has shown that the first generation of drug-eluting stents (1st-gen DES) implantation could elicit coronary conduit artery vasomotor dysfunction at nonstented reference segments as late as 12 months after implantation compared with that seen with bare-metal stents. The mechanism of this phenomenon is still not fully understood. Pathological studies have implicated delayed arterial healing and poor re-endothelialization after the 1st-gen DES implantation. Given the vast use of DES globally, a thorough understanding of the early and long-term safety of these devices is paramount. Therefore, this article systematically reviews the current clinical, pathophysiological, and histopathological available data regarding 1st-gen DES-associated vascular endothelial dysfunction. Meanwhile, we will also review the newer generation of DES and emerging endothelial-friendly technology.
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