Paclitaxel-eluting stents in coronary artery disease

被引:13
作者
Nawarskas, JJ
Osborn, LA
机构
[1] Univ New Mexico, Coll Pharm, Albuquerque, NM 87131 USA
[2] Univ New Mexico, Sch Med, Albuquerque, NM 87131 USA
[3] Univ New Mexico Hosp, Cardiac Catheterizat Lab, Albuquerque, NM 87131 USA
关键词
antineoplastic agents; coronary disease; costs; economics; mechanism of action; mortality; paclitaxel; restenosis; stents;
D O I
10.2146/ajhp040621
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose. Clinical information regarding paclitaxel-eluting coronary artery stents is reviewed. Summary. Restenosis is a significant complication of percutaneous coronary intervention. Coronary artery stenting has reduced restenosis compared with traditional balloon angioplasty, although restenosis still occurs with bare-metal coronary artery stents. The pathogenesis of in-stent restenosis is believed to involve smooth-muscle-cell proliferation and migration in response to vessel injury. A neointimal layer of extracellular matrix and collagen forms, which may impinge on the vessel lumen. Paclitaxel inhibits vascular smooth-muscle-cell proliferation and reduces neointimal mass. Local delivery of paclitaxel through a coronary stent has been shown to reduce restenosis rates and percent diameter stenosis and to produce other angiographic benefits compared with bare-metal stents. Fewer major adverse coronary events are seen with paclitaxel-eluting stents, predominantly because of a reduction in the need for target-vessel revascularization with minimal impact on rates of mortality and myocardial infarction (MI). The Taxus Express(2) stent, the only approved paclitaxel-eluting stent in the United States, costs about three times as much as a bare-metal stent. Cost-effectiveness analyses are needed to determine if the Taxus stent is cost-effective in clinical practice. Conclusion. Paclitaxel-eluting stents reduce the rates of restenosis and target-vessel revascularization compared with bare-metal stents and have comparable effects on mortality and MI rates.
引用
收藏
页码:2241 / 2251
页数:11
相关论文
共 61 条
[1]  
Axel DI, 1997, CIRCULATION, V96, P636
[2]   In-stent stenosis: pathology and implications for the development of drug eluting stents [J].
Bennett, MR .
HEART, 2003, 89 (02) :218-224
[3]  
Blagosklonny MV, 2004, CELL CYCLE, V3, P1050
[4]  
*BOST SCI CORP, TAX V ISR
[5]  
*BOST SCI CROP, TAX EXPR PACL EL COR
[6]  
Büllesfeld L, 2003, Z KARDIOL, V92, P825, DOI 10.1007/s00392-003-0971-y
[7]   Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions [J].
Colombo, A ;
Drzewiecki, J ;
Banning, A ;
Grube, E ;
Hauptmann, K ;
Silber, S ;
Dudek, D ;
Fort, S ;
Schiele, F ;
Zmudka, K ;
Guagliumi, G ;
Russell, ME .
CIRCULATION, 2003, 108 (07) :788-794
[8]   Arterial paclitaxel distribution and deposition [J].
Creel, CJ ;
Lovich, MA ;
Edelman, ER .
CIRCULATION RESEARCH, 2000, 86 (08) :879-884
[9]   Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients [J].
Dibra, A ;
Kastrati, A ;
Mehilli, J ;
Pache, J ;
Schühlen, H ;
von Beckerath, N ;
Ulm, K ;
Wessely, R ;
Dirschinger, J ;
Schömig, A .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (07) :663-670
[10]   Pathological analysis of local delivery of paclitaxel via a polymer-coated stent [J].
Farb, A ;
Heller, PF ;
Shroff, S ;
Cheng, L ;
Kolodgie, FD ;
Carter, AJ ;
Scott, DS ;
Froehlich, J ;
Virmani, R .
CIRCULATION, 2001, 104 (04) :473-479