Safety and efficacy of the drug-eluting stent: a double-edged sword?

Like the introduction of bare metal stents (BMS), that of drug-eluting stents (DES) represented a quantum leap in the interventional cardiology community's ongoing efforts to conquer restenosis. However, recent concerns over late thrombosis (LT) have tempered the initial enthusiasm. Nonetheless, when compared with BMS, the slightly higher DES-LT is counterbalanced by the device's markedly lower incidence of restenosis, resulting in net equivalent rates of death, myocardial infarction, and overall major adverse cardiovascular events. This article summarizes for the noncardiology practitioner the benefits and risks of DES, as well as essentials of postprocedural care of the DES patient. We discuss the pathophysiology of stent thrombosis, pivotal DES trials, and adjunct antiplatelet pharmacology. In December 2006, the Food and Drug Administration convened an expert panel to review these devices. Their recommendations, as well as the joint statement from the American College of Cardiology/American Heart Association/Society of Cardiovascular Angiography and Interventions, are outlined.