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(Circulation. 2007;116:1424-1432.)
© 2007 American Heart Association, Inc.

Advances in Interventional Cardiology

Drug-Eluting Stent Update 2007

Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease)

Antonio Colombo, MD; Alaide Chieffo, MD

From San Raffaele Scientific Institute and EMO Centro Cuore Columbus, Milan, Italy.

Correspondence to Antonio Colombo, MD, EMO Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy. E-mail info@emocolumbus.it

Key Words: angioplasty • coronary disease • myocardial infarction • restenosis • stents • thrombosis

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

	Introduction

 
Randomized trials have largely demonstrated that percutaneous coronary intervention (PCI) with sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) results in a significant reduction in the occurrence of angiographic restenosis and revascularization compared with bare metal stents (BMS).^1–4

The benefit of drug-eluting stents (DES) also has been confirmed in "real-world" scenarios. In this setting, when the analysis was focused on high-risk patient and lesion subgroups, a benefit still existed despite the presence of restenosis.^5–7 These expanded indications do not yet cover many other types of complex lesions for which only registries or randomized trials, not yet published, are available so far (Tables 1 through 7). This topic is discussed in detail in this review. An important clarification is that the lack of proof is most probably due to the difficulty in performing randomized trials in high-risk groups using BMS as controls. It will be no surprise to find that the field in which DES perform best compared with BMS is likely to be complex lesions and patients⁸ (Figure 1).

View this table:   TABLE 1. DES in Unprotected Left Main Stenosis

View this table:   TABLE 2. DES in Bifurcation Lesions

View this table:   TABLE 3. DES in Chronic Total Occlusions

View this table:   TABLE 4. DES in Small-Vessel Disease and Long Lesions

View this table:   TABLE 5. DES in SVGs

View this table:   TABLE 6. DES in Acute MI

View this table:   TABLE 7. DES in Multivessel Disease

View larger version (80K):   Figure 1. Lesion complexity and stent performance in the BMS and DES eras. Adapted from Edelman et al.8

	Unprotected Left Main Coronary Artery

 
Current American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) . . . [Full Text of this Article]

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