Clinical efficacy of a DE stent after an electively planned percutaneous coronary intervention under “real-life” conditions: Prospective registry (first-in-man data)

The success of stent implantation as compared with the outcome of coronary angiography with a balloon dilatation catheter alone has led to the increasingly widespread use of stents in the treatment of coronary heart disease [5,20,22]. However, in-stent restenosis continues to limit the success of this therapeutic mode [11] as is evident from a randomised study published a few years ago, in which 21% of the patients of the group receiving a stent needed a revascularisation procedure within one year, whereas this procedure was required in only 3.8% of the patients in the group with an initial bypass operation [21]. In recent years, stents have been continuously improved though. This improvement mainly refers to mechanical properties, such as stent design, unfolding homogeneity and reduced contamination with fluid and particulate deposits [6,12,19,22]. In a further developmental step, the stents were provided with a passive coating in order to improve their haemocompatibility and thus minimise the interactions between blood cells and the surface of the stent that is foreign to the body [17,18]. This is a fairly consistent step since stainless steel must be regarded to be a thrombogenic material [23]. A number of different coating materials have been used already to date, including, as a special case, metal coatings (such as titanium, titanium oxide, titanium nitrogen oxide, aluminium, gold), ceramics, silicon carbide, various types of carbon (diamond-like carbon, plasma procedure, ion implantation), hyaluronic acid, heparin, collagen, and polymer coatings, such as polyphosphazene, polyethylene carbonate, poly(L-lysine)-poly(ethylene glycol), polyurethane. Though these coatings differ in their effectiveness, they all aim at reducing and even preventing platelet activation, which makes them significantly less thrombogenic than stainless steel.