The Enigma of Drug-Eluting Stents
Hope, Hype, Humility, and Advancing Patient Care
- Robert A. Harrington, MD;
- E. Magnus Ohman, MD
- Author Affiliations: Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
- Corresponding Author: Robert A. Harrington, MD, Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705 (robert.harrington{at}duke.edu).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ADVERSE REACTION
- CORONARY INTERVENTION, PERCUTANEOUS
- DRUG REACTION, ADVERSE
- EQUIPMENT SAFETY
- STENTS
- THROMBOSIS
Interventional cardiology is an iterative science. Advances come in spurts as interventionalists gradually become increasingly familiar with its technologies and limitations. This iterative learning process in the use of percutaneous coronary intervention (PCI) has been tremendous over the last 3 decades. While adverse events were frequent and restenosis was common in the first decade, PCI procedures did relieve symptoms for patients with coronary disease. In the second decade of PCI use, new techniques were developed to scrape, burn, or excise plaque, in an attempt to achieve better outcomes. While there was much hope and hype with these approaches, they all had fundamental problems that prevented their broader use.
Intracoronary bare-metal stents humbled clinicians because warfarin was initially required to prevent in-stent thrombosis and resulted in bleeding complications in many patients. Advances in delivery of bare-metal stents, application of high-pressure balloon inflation, and combination therapy of aspirin and clopidogrel set the …
