Current Pharmaceutical Design - Volume 16, Issue 36, 2010

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 l Read More

Currently approved drug eluting stents (DES) consist of a metallic scaffold and an elutable drug dispersed in a polymer matrix that conformally surrounds the struts. These primarily biostable polymers bind the drug to the stent and modulate the elution of the drug into the arterial tissue. This chapter summarizes the key requirements for polymers used in the DES, including physical properties, stability, compatibility with drugs, Read More

Coronary artery disease is commonly characterized by atherosclerotic obstruction of vessels responsible for providing adequate blood supply to the myocardium. Disruption of atheromatous plaques can promote thrombosis, significant reductions in cardiac perfusion, and devastating acute (i.e, death) or chronic (i.e., congestive heart failure) consequences. Minimally invasive, catheter-based techniques have been implemented t Read More

Sirolimus (rapamycin), a macrolide antibiotic approved for use as an immunosuppressive agent in the prevention of organ rejection, is a cell proliferation inhibitor and regulator of the immune response which acts through inhibition of TOR (target of rapamycin), a kinase essential to cell cycle progression. Recent studies suggest that the TOR pathway is critical to overall cell function, and at a basic mechanistic level, may Read More

The introduction of the drug-eluting stent (DES) has revolutionized the field of interventional cardiology during the past decade. Initial pivotal randomized clinical trials showed a large reduction in restenosis rates and the need for repeat intervention with DES compared with bare-metal stents. The three main components of a DES are 1) the stent platform, 2) a coating facilitating elution of the drug (mostly a polymer), an Read More

Coronary artery stents mechanically buttress the arterial wall and prevent negative remodeling, leading to increased lumen gain and less angiographic and clinical restenosis when compared to balloon angioplasty alone. Although stents prevent negative remodeling, they do not eliminate restenosis, as they cause complex arterial injury, triggering responses that culminate in the induction of neointimal hyperplasi Read More

A vulnerable plaque is an atheromatic plaque with specific morphological characteristics, mainly presented as an unstable collection of white blood cells and lipids in the wall of an artery. It is of great importance to adequately recognize and treat this entity before its rupture, before the initiation of an acute coronary syndrome. The search of the location of future plaque ruptures or plaque erosions is an important area of cardiov Read More

Angioplasty of the coronary arteries has made significant headway in the past 20 years as a treatment for atherosclerotic vascular disease. Though drug-eluting stents are effective, they appear to invoke a thrombogenic response. Biodegradable stents are a promising alternative to permanent stents and may eventually be used to solve the lingering problem of in-stent restenosis. Additionally, fully degradable stents have the abi Read More

Stent thrombosis (ST) is a rare complication following coronary stenting; however given the associated serious consequences, in particular death and myocardial infarction, it remains a source of considerable concern for cardiologists. Although no differences have been found between drug-eluting stents (DES) and bare-metal stents (BMS) in terms of early ST, some studies have reported adverse outcomes associated with D Read More

First generation drug-eluting stents (DES) have significantly improved the treatment options for patients with symptomatic coronary artery disease by decreasing rates of acute vessel closure and restenosis after percutaneous coronary revascularization procedures. However, early enthusiasm was temperd by reports of late stent thrombosis (LST), which raised concerns about safety. Since millions of DES have been implanted in Read More