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More bad news for drug eluting stents , as new dangers emerge in the form of “late stent malapposition”

Posted Jan 17 2010 10:26am

Drug eluting stents have  taken the cardiology community by storm . Millions of drug eluting stents are implanted every year. Sudden stent occlusion without  any warning has been the major threat of DES. Dependence of these patients , on meticulous dual anitplatelet  therapy is another  important caveat .This  issue  gets further complicated as we recognise “ clopidogrel  resistance” in many of this population . This , in effect  pushes these DES  patients  back into higher risk category.

So the cardiology community   cannot afford to  shy  away from answering  the following  vital questions !

How safe is DES  in the long run ? Are we really convinced ?  Is it acceptable to leave a DES patient’s life at the mercy of clopidogrel  which has it’s own idiosyncratic behavior ?



While this debate is getting hot , this new year(  2010) ,  there is  further bad news for DES .

Read this article from  European heart journal 2010

http://eurheartj.oxfordjournals.org/cgi/content/abstract/ehn553

A new complication  termed  ” Late stent malapposition” has been found  to occur  more frequently  in DES  than in other stents !

Stent malapposition could be technical in many , but when it  occurs late , it is  clearly  something to do with stent content  or it’s behavior with the vessel wall .

Some consider it as a partial  late  stent rejection due to late hypersensitivity reaction to the drug and the polymer .

Read a related blog : And now  drug abuse inside the  human  coronary artery

Final message

Drug eluting stents, ( Which  I think ,   has been  released  prematurely  into the  human domain !)  will face a strict scrutiny in the coming years and a turbulent time is expected.

Future perfect ? All the following statements can be true in isolation !

  • Even , plain balloon angioplasty (POBA) can be appropriate or  preferred over stents in many lesions.
  • Bare metal  stents are often better than DES .
  • Biodegradable  stents could prove  better than DES
  • And finally , medical management  ( if  effective and feasible  )  could be better than best stent

Reference

http://www.invasivecardiology.com/articles/Late-Acquired-Stent-Malapposition-after-Sirolimus-Eluting-Stent-Implantation-Full-title-bel

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