Drug-eluting stents and vulnerable plaque

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.