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Drug-eluting stent

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An example of a drug-eluting stent. This is the TAXUS™ Express™ Paclitaxel-Eluting Coronary Stent System, which releases paclitaxel.

In medicine, a drug-eluting stent is a stent (a metal scaffold) placed into diseased coronary arteries that slowly releases a drug blocking cell proliferation; this helps to delay or prevent the artery from being re-occluded by smooth muscle and clot (thrombus). The stent consists of a expandable metal framework, a drug to prevent restenosis, and a carrier to slowly release the drug. It is placed over a balloon on a catheter and guide wire and introduced through a peripheral artery, usually one of the femoral arteries. It is threaded back towards the heart; from the aorta, the appropriate coronary artery is entered. The balloon is inflated, cracking and compressing the plaque and expanding the stent. The balloon and catheter are then withdrawn, leaving the stent in place. The stent releases its drug over the next several months. Patients must take antiplatelet therapy afterwards, usually clopidogrel for six months and aspirin indefinitely. Drug-eluting stents have been shown to be superior for many of the conditions that traditional stents (“bare-metal stents”) have been used, and have become quite popular since their FDA approval in 2003.

History

Heart attacks, or myocardial infarctions, are major causes of death and disability; they result when a portion of heart muscle dies from inadequate blood flow. This typically occurs at sites where coronary arteries are already narrowed and damaged. If blood flow can be restored early enough, permanent damage can be prevented, and preemptive restoration can prevent heart attacks from occurring in the first place. The first procedural method to perform a type of open-heart surgery called coronary artery bypass graft (CABG) surgery, which uses a section of vein or artery from elsewhere in the body to bypass the diseased vessel. In 1977, Andreas Grüntzig introduced percutaneous transluminal coronary angioplasty (PTCA), in which a catheter was introduced through a peripheral artery and a balloon expanded to compress and crack the obstructive plaque.

References

  1. Michel, Thomas (2006) . "Treatment of Myocardial Ischemia". In Laurence L. Brunton, John S. Lazo, & Keith L. Parker (ed.). Goodman & Gilman’s: The Pharmacologic Basis of Therapeutics (11th ed. ed.). New York: McGraw-Hill. p. 842. {{cite book}}: |edition= has extra text (help)CS1 maint: multiple names: editors list (link)
  2. Serruys, Patrick W. (2006-02-02). "Coronary-Artery Stents". New England Journal of Medicine. 354 (5): 483–495. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) (extract)
  3. "New Device Approval — Cypher Sirolimus-eluting Coronary Stent". Food and Drug Administration. Retrieved 2006-07-22.
  4. Grüntzig, AR (1979-07-12). "Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty". New England Journal of Medicine. 301 (2): 61–68. Retrieved 2006-07-22. {{cite journal}}: Check |authorlink= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) (abstract)

See also