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Second- and third-generation drug-eluting coronary stents

Progress and safety

Medikamentenbeschichtete Stents der 2. und 3. Generation

Vorteile und Sicherheit

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Abstract

Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by reducing the rate of in-stent restenosis from 20–40% with bare-metal stent (BMS) to 6–8% with DES. However, with widespread use of DES, safety concerns have risen due to the observation of late stent thrombosis. With this in mind and better understanding of mechanism and pathophysiology of stent thrombosis, the technological platform, especially innovative anti-restenotic agents, polymeric coatings, and stent platforms, improved with newer DES. Two second-generation DES, the Endeavor zotarolimus-eluting stent (ZES) and the Xience-V everolimus-eluting stent (EES), have provided promising results in both randomized controlled trials (SPIRIT and ENDEAVOR) and registries (E-Five, COMPARE) compared with bare-metal stents (BMS) and first-generation DES. Newer third-generation stent technology, especially biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly-L-lactide (PLLA) or magnesium, has been evaluated in preclinical and initial clinical trials. However, despite encouraging initial results, long-term data of large-scale randomized trials as well as registries comparing them to currently approved first- and second-generation DES are still lacking.

Zusammenfassung

Der Einsatz der medikamentenbeschichteten Stents (DES) hat die interventionelle Therapie der koronaren Herzkrankheit durch Abnahme der Restenoserate, die bei unbeschichteten Stents (BMS) bei 20–40% lag, auf 6–8% reduziert. Mit dem verbreiteten Einsatz und angesichts der Beobachtung von späten Stent-Thrombosen kamen Bedenken hinsichtlich der Sicherheit für die Patienten auf. Das wachsende pathophysiologische Verständnis für die Ursachen von Stent-Thrombosen hat zu einer Weiterentwicklung der Stents, insbesondere der antiproliferativen Medikamente, der Polymerbeschichtung, und des Stent-Plattform, geführt. Beide DES der 2. Generation, der Zotarolimus-beschichtete (ZES) Endeavor-Stent sowie der Everolimus-beschichtete (EES) Xience-V-Stent, liefern sowohl in randomisierten kontrollierten Studien (SPIRIT, ENDEAVOR) als auch in Registern (E-Five, COMPARE) beim Vergleich mit den unbeschichteten Stents (BMS) und den DES der 1. Generation erfolgversprechende Ergebnisse und höhere Sicherheit für Patienten. Neuere Stent-Technologien der 3. Generation, insbesondere biodegradierbare Polymere, polymerfreie Stents sowie biodegradierbare Stents auf Basis von Poly-L-Lactidsäure (PLLA) oder Magnesium, wurden in präklinischen und ersten klinischen Studien untersucht. Trotz vielversprechender Ergebnisse fehlen noch Langzeitergebnisse von größeren Patientenkollektiven, die mit dieser neueren Stent-Konzeption behandelt wurden.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Heart Center RostockDepartment of Internal Medicine I, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    I. Akin, H. Schneider, H. Ince, S. Kische, T.C. Rehders, T. Chatterjee & C.A. Nienaber MD, PhD

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  1. I. Akin
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  2. H. Schneider
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  3. H. Ince
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  4. S. Kische
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  7. C.A. Nienaber MD, PhD
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Correspondence to C.A. Nienaber MD, PhD.

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Akin, I., Schneider, H., Ince, H. et al. Second- and third-generation drug-eluting coronary stents. Herz 36, 190–197 (2011). https://doi.org/10.1007/s00059-011-3458-z

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