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
Dr.S.Venkatesan MD 
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