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Concept
Drug-eluting stent
Résumé
A drug-eluting stent (DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly release a drug to block cell proliferation. This prevents fibrosis that, together with clots (thrombi), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the peripheral or coronary artery by an interventional cardiologist or interventional radiologist during an angioplasty procedure.
Drug-eluting stents in current clinical use were approved by the FDA after clinical trials showed they were statistically superior to bare-metal stents for the treatment of native coronary artery narrowings, having lower rates of major adverse cardiac events (usually defined as a composite clinical endpoint of death + myocardial infarction + repeat intervention because of restenosis). The first drug-eluting stents to be approved in Europe and the U.S. were coated with paclitaxel or an mTOR inhibitor, such as sirolimus.
It is crucial to identify patients who are good candidates for procedural intervention. Generally, patients without symptoms of coronary blockage or without evidence of ischemia (oxygen deprivation) on labs and imaging are not subjected to stent procedures, as the complications and risks of such a procedure would outweigh any potential benefit.
Procedural intervention, such as angioplasty or stent placement, is reserved for patients with clinical symptoms of coronary artery flow reduction or observable coronary artery obstruction on imaging. This is otherwise known as a myocardial infarction (heart attack). These symptoms can include, but are not limited to:
Severe, pressure-like chest pain unrelieved by rest
Shortness of breath, fatigue, lightheadedness
Palpitations
Atypical symptoms: nausea, vomiting, indigestion, confusion, back pain
There are two major classifications of myocardial infarction (MI): ST-elevation MI vs. non-ST elevation.
Source officielle
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