Late Angiographic Stent Thrombosis: The LAST Straw for Drug-Eluting Stents?

Abstract

The long-term patency advantage of drug-eluting stents represents a quantum leap in the percutaneous treatment of ischemic heart disease. Although initial landmark trials demonstrated equivalent safety to bare-metal stents, subsequent follow-up analyses have suggested a slight late thrombotic risk. This widely publicized issue poses major public health implications for the medical and lay communities. However, available data indicate that this late risk is counterbalanced by the dramatic drug-eluting stent reduction in target lesion revascularizations, resulting in equivalent overall major adverse cardiovascular event rates than that of the bare-metal stents The recent Food and Drug Administration's guidelines regarding these devices are delineated in detail. Specifically, compliance with dual antiplatelet therapy (minimum 1 year) is of paramount consideration in patient selection for drug-eluting stents. Moreover, when deployed for “on-label” indications, they provide significant restenosis advantage, with a slight late thrombotic risk but without overall increase in death or infarction.