Choice of DES: A European Clinician's Perspective

The introduction of the first generation of drug‐eluting stents (DES) in 2002 revolutionized interventional cardiology by minimizing restenosis. Reports of increased late stent thrombosis with these stents compared with bare metal stents, probably due to delayed endothelialization, emerged late in 2006. These studies contained serious methodological flaws, however. Subsequent meta‐analyses clearly showed only a small incremental risk of late stent thrombosis across all patient groups. Importantly, a significant and sustained benefit of DES due to reduced restenosis and thus repeat revascularization was also shown. Several “real‐world” registries have confirmed these results, as well as suggesting that use in more complex situations is not associated with adverse outcomes. Stent thrombosis is a multifactorial problem, in which the stent is only one element. Further research is required to determine optimal procedural technique and antiplatelet regimes. Second‐generation DES, with different antiproliferative drugs and more biocompatible polymers, have shown promising results in comparative studies with the first generation. Current follow‐up data for these stents is only up to 3 years, however. DES are safe and effective in the long term, though intensive research continues into ways to reduce the risk of stent thrombosis in the next generation.