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To better understand the issues and opinions involved in the continued discussion of the relative benefits of each stent class, we invited Dr. Michael P. Thomas and Dr. Antonio Colombo to create a set of "Pro-Con" articles representing the extreme positions. Their opinions offer an excellent opportunity to provide science for the passion.

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Role of coronary drug-eluting stents in current clinical practice

George W. The development of coronary stents greatly improved the outcomes and safety of percutaneous coronary intervention PCI. However, the delay in vessel healing associated with DES was associated with increased rates of late stent thrombosis and the requirement for longer duration dual antiplatelet therapy DAPT. The benefit of DES in smaller vessels is attenuated in large diameter vessels 3. Steinberg and colleagues examined outcomes at 30 days, 6 months, and 1 year in patients with DES in vessels at least 3. There was no significant difference in the primary composite endpoint of death from cardiac causes or nonfatal MI at 2 years.

Premature discontinuation of DAPT is the major risk factor for stent thrombosis. They were also less likely to have received discharge instructions about their medications or a cardiac rehabilitation referral. Importantly, they were more likely to die during the next 11 months 7. The second most common reason for discontinuation of DAPT is the need for noncardiac surgery within 1 year of stent implantation. Surgery may be considered 3 months after DES implantation if the risk of further delay is greater than the expected risks of stent thrombosis Class IIb. Furthermore, BMS are attractive options in areas of the world where patients are required to pay the cost of their medical procedures.

Patients with recent bleeding are poor candidates for longer duration DAPT. Additionally, longer duration DAPT may place other patient subgroups, such as elderly patients, at an unacceptably high bleeding risk. The rates of DAPT at 1 year were The optimal antiplatelet regimen after stenting for patients taking oral anticoagulants continues to be investigated.


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BMS should continue to play an important role in those taking oral anticoagulants who are at higher risk for bleeding. As stent technology continues to improve and antiplatelet regimens become more tailored, BMS will still serve an important role in PCI. Send a copy to your email.

Advanced Stents for Cardiovascular Applications

Some error has occurred while processing your request. Please try after some time. Y-lC and JF contributed equally to the work. The authors have no conflicts of interest to disclose. Supplemental Digital Content is available for this article.

Advanced Stents for Cardiovascular Applications | SpringerLink

Abstract 1 Introduction 2 Methods 2. Back to Top Article Outline. Figure 1. Figure 2.


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    Drug-Eluting Stent Technology: Optimizing Patient Outcomes

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    Why might I need angioplasty?

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    Inflammation and its resolution as determinants of acute coronary syndromes. Circ Res ;— Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. Keywords: antiproliferative drug ; meta-analysis ; permanent polymer drug-eluting stent ; polymer-free drug-eluting stent. Polymer-free drug-eluting stents versus permanent polymer drug-eluting stents: An updated meta-analysis.

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