The Paclitaxel-Eluting Stent in Percutaneous Coronary Intervention

Publisher Website
Google Scholar
Abstract
The development of coronary artery stents that release (elute) a drug locally into the diseased vasculature has revolutionized the practice of interventional cardiology. These devices were designed to minimize the incidence of in-stent restenosis that may occur with bare metal stents. The paclitaxel-eluting stent is the most recent drug-eluting stent approved for use in the United States and is a bare metal stent coated with paclitaxel that is gradually released from the stent into the vessel wall with undetectable systemic concentrations of the drug. Paclitaxel functions to stabilize the assembly of microtubules, thereby interfering with cell division, motility, and shape, and ultimately inhibiting smooth muscle cell proliferation and migration, key processes in the development of neointimal hyperplasia during in-stent restenosis. Clinical trials have repeatedly demonstrated the superiority of the paclitaxel-eluting stent over the bare metal stent in terms of reducing restenosis rates and percent stenosis diameter as well as other angiographic end points. Although the rates of major adverse cardiac events are reduced with the paclitaxel-eluting stent compared with the bare metal stent, this is primarily the result of a reduction in the need for target vessel revascularization, whereas rates of myocardial infarction and death have not been shown to be significantly affected.