Advances in dual therapy stenting.

Interventional cardiovascular medicine is in continuous evolution. Introduction of drug-eluting stents (DES) in clinical practice drastically improved the efficacy of percutaneous coronary intervention by reducing the risk of in-stent restenosis through the abluminal elution of an antiproliferative drug to suppress neointimal hyperplasia. Unfortunately, safety issues rose with first-generation DES due to incomplete luminal stent strut endothelialization and subsequent risk of late and very-late thrombosis. While 2nd-generation DES addressed some of the safety issues observed with 1st-generation DES, some limitations remain. Dual therapy stenting is an innovative technology developed with the rationale of combining a highly effective antiproliferative drug elution on the abluminal side and an endothelial progenitor cell capture system on the luminal side to accelerate stent strut endothelialization; thus potentially preventing the early and late complications of incomplete endothelial coverage while maintaining an antirestenotic effectiveness. Additionally, a DES platform associated with more predictable and faster endothelialization pattern may be an important therapeutic option in patients at high-risk for bleeding who cannot tolerate even short regimens of dual antiplatelet therapy. The present article reviews the most recent developments in dual therapy stenting from its rationale to the preclinical and clinical studies.