This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ryan, J. Articles by Cohen, D. J. Search for Related Content PubMed PubMed Citation Articles by Ryan, J. Articles by Cohen, D. J. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Related Collections Health policy and outcome research Restenosis Catheter-based coronary interventions: stents Chronic ischemic heart disease

(Circulation. 2006;114:1736-1744.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Will drug-eluting stents bankrupt the healthcare system?

Are Drug-Eluting Stents Cost-Effective?

It Depends on Whom You Ask

Jason Ryan, MD, MPH; David J. Cohen, MD, MSc

From the Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass (J.R.), and Saint Luke’s Mid America Heart Institute, Kansas City, Mo (D.J.C.).

Correspondence to David J. Cohen, MD, MSc, Cardiovascular Research, Saint Luke’s Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail dcohen@saint-lukes.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Since their commercial introduction in 2003, drug-eluting stents (DES) have rapidly altered the management of coronary artery disease. Before their development, the percutaneous management of coronary artery disease was performed predominantly by implantation of bare metal stents (BMS) made of either surgical stainless steel or metal alloys. Although such stents represented a considerable advance over balloon angioplasty alone, they remained limited by restenosis resulting from neointimal proliferation. As a result, 15% to 20% of patients treated with BMS required 1 repeat revascularization procedure within the 6 to 12 months after stent implantation.¹ Despite numerous attempts at systemic pharmacotherapy, device modification, and even use of ionizing radiation, the rate of restenosis after BMS implantation remained largely unaffected.

Response by Eisenberg p 1744

Over the past 5 years, effective DES have become the first device to substantially reduce the incidence of restenosis after stent implantation. By delivering high concentrations of either antiproliferative or immunomodulatory compounds directly to the site of arterial injury and by controlling this delivery through polymer-based drug release, both sirolimus- and paclitaxel-eluting stents have safely and effectively inhibited the proliferative process that results in in-stent restenosis. In pivotal clinical trials, both sirolimus- and paclitaxel-eluting stents have reduced rates of angiographic restenosis by 70% to 90% compared with conventional BMS designs, with parallel reductions in the need for clinically driven target vessel revascularization (TVR).^2–4 As a result, in April 2003, DES were approved for use in clinical practice in the United States. Within 9 months of their introduction, DES made . . . [Full Text of this Article]

This article has been cited by other articles:

				J. Ryan, W. Linde-Zwirble, L. Engelhart, L. Cooper, and D. J. Cohen Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras: Results From the US Medicare Program Circulation, February 24, 2009; 119(7): 952 - 961. [Abstract] [Full Text] [PDF]

				J. A. Ezekowitz What Price to Pay?: The Cost of Everything and the Value of Nothing Circulation, January 27, 2009; 119(3): 368 - 370. [Full Text] [PDF]

				J. C.J. Sun, J. W. Eikelboom, P. Agostoni, G. M. Sangiorgi, G. G. Biondi-Zoccai, B. Scheller, M. Bohm, and E. Camenzind Treatment of Restenosis with a Paclitaxel-Coated Balloon Catheter N. Engl. J. Med., March 8, 2007; 356(10): 1071 - 1073. [Full Text] [PDF]