Drug-eluting stents: insights into safety and indications

Currently, more than 4 million patients receive drug-eluting stents worldwide. Despite recent studies and editorials that have stirred controversy and generated tremendous publicity in the lay press related to the safety of drug-eluting stents for the treatment of coronary artery disease, enthusiasm for drug-eluting stents remains high. Drug-eluting stents decrease the need for repeat revascularization, but exhibit delayed endothelialization compared with bare metal stents. Adverse late vessel wall remodeling and inflammation have also been attributed to the drug/polymer coating. Recent registry analysis data suggesting an increased risk of late or very late thrombosis with drug-eluting stents in routine clinical practice compared with previous clinical trial experience has led to concerns regarding the long-term safety of these devices. Clearly, there are many benefits to drug-eluting stents, which are an excellent and appropriate revascularization treatment for many patients with substantial reduction of restenosis compared with bare-metal stents. There is a need for understanding the benefits and risks of these devices in order to use them optimally and reduce likelihood of thrombosis. This review sheds some light on the risks and benefits of drug-eluting stents, and puts this treatment in perspective compared with alternative revascularization treatment options for obstructive coronary artery disease. The important take-home message is that the risks of drug-eluting stent thrombosis versus bare-metal stent thrombosis may have been overstated by some studies.