Stent, drug, polymer—enefits, risks, and opportunities

It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal prolif-eration following stenting and that this is reflected clini-cally in a very significant decrease in late lumen loss, in-stent restenosis, and target lesion revascularization. This benefit occurs, however, in the setting of delayed endothe-lial and vascular wall healing with its potential for continu-ing thrombogenicity requiring more prolonged use of dual antiplatelet therapy to prevent stent thrombosis. Large se-ries of patients receiving sirolimus-eluting and paclitaxel-eluting stents have indicated the absence of any increase in adverse cardiac events up to one year following stenting. Questions have been raised, however, as to whether there may be any late "catch-up" in restenosis or in late stent thrombosis.