oa Editorial [Hot topic: Current Status of Drug Eluting Stents (Executive Editor: Nicholas Kipshidze)]

Coronary stent implantation has become a well-established therapy in the management of coronary artery disease. Although the STRESS (Stent Restenosis Study) and BENESTENT (Belgium-Netherlands Stent) trials demonstrated convincingly that stenting is superior to PTCA with respect to restenosis in de novo lesions, there is however a still high incidence (10 to 50%) of restenosis following stent implantation depending on lesion and patient characteristics. Improvements in stent design and implantation techniques resulted in an increase in the use of coronary stents and today in most centers in USA and Europe stenting has become the predominant form of nonsurgical revascularization and accounts for about 90% of all procedures. Coronary stents provide luminal scaffolding that virtually eliminates elastic recoil and remodeling. Stents, however, do not decrease neointimal hyperplasia and in fact lead to an increase in the proliferative component of restenosis. Agents that inhibit cell-cycle progression indirectly have also have been tested as inhibitors of vascular proliferation. Sirolimus (Rapamune, Rapamycin), a macrolide antibiotic with immunosuppressive properties and its analogues, Paclitaxel (Taxol) inhibit neointimal formation in animal models when loaded onto coated stents. Preliminary clinical studies with drug eluting stents (DES) produced dramatic results eventually eliminating restenosis in large and midsize arteries. This was later confirmed in large randomized clinical trials and demonstrated the benefit of DES in patients with a high risk for restenosis. There is no doubt that DES dramatically reduces the rate of angiographic restenosis and the clinical need for repeat revascularization procedures. DES enables cardiologists to perform procedures in complex lesions, in which surgery would have been the only option before the advent of DES. However, so far no beneficial effect on death and re-infarction was observed in any of the randomized clinical trials. There are still concerns regarding an increase in the rate of late stent thrombosis. Certainly DES technology is a definitive step forward to optimize the results of PCI. However, before we can recommend a DES for every patient, the long-term safety and efficacy issues have to be solved. In this issue, a multidisciplinary team of international experts discuss all the most relevant topics on stent-based treatment techniques including polymer coating designs [1], mechanism of action of different pharmaceuticals on restenosis [2,3] comprehensive reviews of major clinical studies [4,5], new stents for vulnerable plague [6], next generation DES developments including biodegradable and bioabsorbable stents [7], discussion of duration of dual antiplatelet therapy [8] alongside with pathobiology of stent thrombosis [9].