Delayed coronary artery healing after implantation of drug-eluting stents is a concern

65

The delayed healing of the coronary artery following implantation of of drug-eluting stents, which increases patients’ risks of developing thrombosis, is a top concern today of interventional cardiologists, according to the results of a survey announced at EuroPCR 2013 in Paris, France (21–24 May).

In the online survey of 141 interventional cardiologists in Belgium, China, Denmark, Germany, Italy, Malaysia, The Netherlands, Singapore and the UK, participants responded to questions about their familiarity with delayed arterial healing, the degree to which it was a concern in their clinical practices, and the importance of the next generation of stents to address this challenge. The survey, sponsored by OrbusNeich, according to a press release sought to quantify concerns raised by physicians involving the effects of the drug and polymer combinations of drug-eluting stents on the healing of the coronary artery following percutaneous coronary intervention. According to data published in Circulation, approximately 76% of stents implanted during percutaneous coronary intervention are drug-eluting stents as opposed to bare metal stents.

The survey results revealed that:

  • 97% of cardiologists surveyed are very concerned about delayed arterial healing and its implications
  • 75% of cardiologists surveyed discuss the risks associated with delayed arterial healing with their patients
  • 41% of cardiologists surveyed always or often select a stent based on their awareness and understanding of delayed arterial healing, while 50% sometimes do
  • 99% of cardiologists surveyed agree that the next generation of stents must address the challenge of delayed arterial healing

Contemporary drug-eluting stents, which are designed to delay formation of new tissue, have been associated with delayed arterial healing and the prevalence of latent thrombus after five years, suggesting that patients may continue to be at risk for late and very late stent thrombosis long after percutaneous coronary intervention. To mitigate the risk for stent thrombosis, treatment with drug-eluting stents is accompanied by long-term dual antiplatelet therapy. The most recent guidelines from the European Society of Cardiology acknowledge that the “optimal duration of dual antiplatelet therapy after drug-eluting stent implantation is not known” and suggest that patients remain on dual antiplatelet thearpy for at least six months.