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Drug Eluting Stent Technology

A Paradigm Shift in the Treatment and Prevention of Restenosis

The Johns Hopkins Hospital, Department of Pharmacy, 600 North Wolfe Street, Carnegie 180, Baltimore, MD 21287, The Johns Hopkins Hospital, Baltimore, Maryland

Navin K. Kapur, MD

The Johns Hopkins Hospital, Baltimore, Maryland

The authors discuss the mechanism of action, clinical trial data, and economic impact of both the paclitaxel and sirolimus drug eluting stents (DESs). Both DESs have been approved by the Food and Drug Administration for the treatment of native coronary arteries to prevent in-stent restenosis (ISR), which patients have experienced since the advent of balloon angioplasty and the bare metal stent. In-stent restenosis, which manifests itself as ischemic symptoms in patients, occurs as a result of the healing process after stent implantation. Until now, there has not been an effective method to prevent ISR. The sirolimus and paclitaxel DESs elute agents that act locally by different mechanisms to reduce neointimal hyperplasia, which is primarily responsible for ISR. Both DESs are capable of reducing the rate of ISR. There are certain physical and mechanistic differences between the 2 stents; the stents have not been compared head to head. Currently, they are indicated for uncomplicated native coronary lesions. Further investigation is needed to define their roles in the treatment of more complex lesions.

Key Words: Angina • angioplasty • drug eluting stent • paclitaxel • sirolimus • in-stent restenosis

Journal of Pharmacy Practice, Vol. 18, No. 6, 461-478 (2005)
DOI: 10.1177/0897190005282359


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