The Unrestricted Use of Paclitaxel-Eluting Stents and Sirolimus-Eluting Stents in the Rotterdam T-SEARCH and RESEARCH Registries: Studies on Efficacy, Safety, Stent Thrombosis, Cost Effectiveness and the Future

This year, 2007, marks the 30th anniversary of the first percutaneous coronary intervention, in the form of a percutaneous transluminal coronary angioplasty (PTCA) or balloon angioplasty, by Andreas Gruentzig.<br/> 1 It is also the 20th anniversary of the first report of the use of a stent to maintain vessel patency following balloon angioplasty.<br/> 2 Up until recently, the major limitation to stent implantation was restenosis, or renarrowing, at the site of stent implantation, leading to recurrence of angina. Th s occurred in between 10 to 50% of patients. In 2000, the first reports of a revolutionary new stent, the drug-eluting stent began to emerge, with early promises of zero restenosis.<br/> 3 In 2003, the fi rst drug-eluting stent was commercialised, coated with the immunosuppressive agent sirolimus, leading to the sirolimus-eluting stent, and followed in 2004 by the paclitaxel-eluting stent. The trials performed that led to the commercialisation of drug-eluting stents were in simple lesions, to reduce the number of confounding factors.<br/> 4 The patients studied in these trials make up only 25% of the typical patient population seen in a cardiac catheterisation laboratory. For the remaining 75%, it was extrapolated that these drug-eluting stents would be safe and efficacious, but that assumption required proving.

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