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Dr. Jean Fajadet ,
This symposium focused on failures and pitfalls of DES. The first speaker, B O’Murchu, from Philadelphia, presented the incidence and implications of suboptimal initial results of coronary stent implantation. He reported the decrease of complications rates (failure to stent, stent thrombosis, restenosis, bleedings) from 1991 to nowadays, insisting on the role of dual antiplatelet therapy, IVUS guidance, technique in stent deployment with large balloon, high pressure and balloon-artery ratio close to 1.1 in order to reduce the risk of incomplete stent apposition. The issue of restenosis was treated by A Kastrati from Munich, Germany. Following the 0% restenosis of Ravel study, all the other studies reported a low but non negligible rate of in-stent restenosis after DES implantation when treating more complex lesions in more complex patients. He analysed the three components of DES: the platform, the drug and the polymer with its implication on the release and the kinetics of the drug delivery. He clearly reported the improvement of the results in efficacy with the new generation of DES. The safety problem of stent thrombosis was reported by A Chieffo from Milan. She observed a global decrease of stent thrombosis since 1991 and described its different factors: the patient, the lesion, the device, the procedure, the platelets and coagulation factors. Timing of stent thrombosis (early, late, very late), the role of premature discontinuation of dual antiplatelet therapy, the doses of Clopidogrel, the issue of genotype or phenotype assessment and the efficacy of the new antiplatelet dugs (Prasugrel, Ticagrelor) was analysed. Finally, F Alfonso Manterola focused on the incidence, the causes, the diagnosis and the treatment of coronary aneurysms and stent fractures after DES implantation. In summary, this was an excellent review of failures after PCI using DES.
Drug-eluting stents sometimes fail!
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