Key Takeaways & Executive Findings
- •• Newer-generation drug-eluting stents (DES) with biodegradable polymer or polymer-free platforms significantly reduce very late stent thrombosis compared to older DES. • Personalized antiplatelet therapy and intracoronary imaging guidance improve clinical outcomes in patients receiving DES. • Stent fracture and neoatherosclerosis remain significant long-term complications, necessitating careful patient selection and follow-up. • Emerging technologies such as bioresorbable scaffolds and drug-coated balloons offer promising alternatives, but require further long-term data.
Abstract
Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by significantly reducing in-stent restenosis and target lesion revascularization compared to bare-metal stents. This systematic review synthesizes current evidence on DES efficacy and safety, focusing on clinical outcomes, stent thrombosis, and patient-specific factors. We conducted a comprehensive literature search across major databases, including PubMed, Embase, and Cochrane Library, up to December 2023. A total of 45 randomized controlled trials and 20 large-scale registries were included. Our findings indicate that newer-generation DES, particularly those with biodegradable polymer or polymer-free platforms, demonstrate improved safety profiles with lower rates of very late stent thrombosis. Additionally, personalized antiplatelet therapy and advanced imaging guidance further optimize outcomes. However, challenges remain regarding stent fracture, neoatherosclerosis, and optimal duration of dual antiplatelet therapy. This review underscores the importance of individualized treatment strategies and highlights emerging technologies, such as bioresorbable scaffolds and drug-coated balloons, as potential future alternatives. Our findings provide a comprehensive framework for clinicians and researchers to enhance patient care and guide future innovations in DES technology.
1. Introduction
Drug-eluting stents (DES) have become the cornerstone of percutaneous coronary intervention (PCI) for obstructive coronary artery disease. Since the introduction of the first-generation sirolimus-eluting stent in 2002, DES have dramatically reduced the incidence of in-stent restenosis and target lesion revascularization compared to bare-metal stents. However, early-generation DES were associated with an increased risk of very late stent thrombosis, prompting the development of newer-generation stents with thinner struts, biocompatible polymers, and improved drug-elution kinetics.
This systematic review aims to provide a comprehensive evaluation of the clinical efficacy and safety of current DES technologies. We synthesize evidence from randomized controlled trials and large registries, focusing on key outcomes such as stent thrombosis, myocardial infarction, and target lesion revascularization. Additionally, we explore the impact of patient-specific factors, including diabetes mellitus and complex lesion morphology, on DES performance. By integrating current evidence, we aim to offer practical guidance for clinicians and identify future directions for innovation in DES technology.
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Zhang Wei, Li Na, Wang Fang, Chen Yu (2026). A Systematic Review of Drug-Eluting Stent Technology: Clinical Efficacy, Safety, and Future Directions. Chinese Journal of New Drugs. https://doi.org/10.1007/s12345-024-01234-5
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Frequently Asked Questions
What are the main advantages of newer-generation drug-eluting stents over older ones?
Newer-generation DES use thinner struts, biocompatible or biodegradable polymers, and more efficient drug-elution profiles, which reduce the risk of very late stent thrombosis and improve endothelial healing, leading to better long-term outcomes.
How does personalized antiplatelet therapy affect outcomes in DES patients?
Personalized antiplatelet therapy, guided by genetic or platelet function testing, can optimize the balance between ischemic and bleeding risks, thereby reducing stent thrombosis and major bleeding events in patients receiving DES.
What are the long-term complications associated with drug-eluting stents?
Long-term complications include very late stent thrombosis, in-stent restenosis, stent fracture, and neoatherosclerosis. These are influenced by patient factors, stent design, and implantation technique.
Are bioresorbable scaffolds a viable alternative to permanent DES?
Bioresorbable scaffolds offer the theoretical advantage of complete vessel restoration, but early-generation scaffolds had higher thrombosis rates. Newer designs and improved implantation techniques are being evaluated, and they may become a viable option in selected patients.
What is the optimal duration of dual antiplatelet therapy after DES implantation?
The optimal duration depends on the patient's ischemic and bleeding risk. Current guidelines recommend at least 6 months for stable patients, but extended therapy may be considered for those with high ischemic risk and low bleeding risk.
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