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Published on: May 14, 2013
Dual antiplatelet therapy, drug-eluting stents and bioresorbable vascular scaffolds: Evolutionary perspectives
Felipe N Albuquerque1, Anna Bortnick1, Javaid Iqbal2
1Division of Cardiovascular Diseases-Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Insights
Dual antiplatelet therapy is crucial after percutaneous coronary intervention. Optimal duration depends on device type and patient risk for bleeding or ischemia.
Area of Science:
- Cardiology
- Biomaterials Science
Background:
- Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) to prevent thrombotic events.
- Stent thrombosis remains a serious complication despite advances in device technology and understanding of pathophysiology.
Purpose of the Study:
- To review the optimal duration of DAPT following PCI.
- To evaluate the role of novel device technologies, such as bioresorbable vascular scaffolds (BVS), in influencing DAPT duration.
Main Methods:
- Review of recent large-scale randomized trials comparing different PCI devices and DAPT durations.
- Analysis of factors influencing ischemic and hemorrhagic complication risks.
Main Results:
- Bioresorbable vascular scaffolds offer potential advantages including restoration of vasomotion and elimination of long-term foreign body response.
- Optimal DAPT duration may vary based on the specific stent or scaffold used.
- Individual patient risk assessment for ischemic versus bleeding complications is critical.
Conclusions:
- The choice of coronary device, including bioresorbable scaffolds, impacts the optimal duration of dual antiplatelet therapy.
- Personalized DAPT strategies are necessary, balancing the risk of stent thrombosis against bleeding complications.
Abstract:
Dual antiplatelet therapy reduces the risk of myocardial infarction, stent thrombosis, and cardiovascular mortality after percutaneous coronary intervention, but the optimal duration of therapy remains unclear. Stent thrombosis, one of the most feared complications of coronary intervention, is associated with high mortality and morbidity and is related in part to technical and patient-specific factors. Advances in device technology and better understanding of the pathophysiology of stent thrombosis have reduced the frequency of this devastating complication. Bioresorbable vascular scaffolds possess a number of advantageous features and are currently undergoing active investigation. Bioresorbable vascular scaffolds have been demonstrated to restore physiologic vasomotion, allow for late lumen enlargement, and upon full resorption remove the nidus for very late polymer reactions and resolve concerns of stent malapposition and side branch jailing. Based on the results from recent large-scale randomized trials, the optimal duration of dual antiplatelet therapy may depend on the choice of device type, as well as the individual patient risk of ischemic versus hemorrhagic complications.
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