A Stent (or Two) in Time Saves

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Science  07 May 2004:
Vol. 304, Issue 5672, pp. 799
DOI: 10.1126/science.304.5672.799b

Each year more than 900,000 patients with coronary artery disease are treated by angioplasty, followed by implantation of a coronary stent, a mechanical device designed to keep the artery open. Nevertheless, in 20 to 30% of the cases, the stented artery narrows over time and often requires further treatment to reduce blockage. This occurs because vascular smooth muscle cells migrate into the lumen of the stent and proliferate, forming scar tissue. To address this restenosis problem, a number of pharmaceutical companies have developed drug-eluting stents: devices coated with a thin polymer that slowly releases an antiproliferative drug.

Holmes et al. and Stone et al. report the results of two large randomized clinical trials designed to assess the efficacy of stents, releasing the drugs sirolimus (rapamycin) and paclitaxel, respectively. In both trials, after 1 year of patient follow-up, the drug-eluting stents performed significantly better than bare-metal stents, reducing the frequency of vessel retreatment to less than 5%. Although these results are encouraging, it remains unclear whether the drug-eluting stents are inhibiting or simply delaying restenosis—a question that can only be addressed through longer-term studies. — PAK

Circulation 109, 634;1942 (2004).

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