Drug-Eluting Stenting (DES)
When doctors perform an angioplasty (a catheter procedure to open a narrowed artery), they often insert a mesh metal tube called a stent to prevent the artery from closing again in the future. The tissue of the artery heals around the stent to hold it in place, but sometimes this healing process can involve a buildup of scar tissue, which increases the risk of a blockage reforming in the future (a condition called restenosis).
Drug-eluting stents (DES) are coated with a slow-release medication that helps to inhibit scar tissue growth thus reducing the chance of restenosis by keeping the artery open. Although negative press linking DES with late-stent thrombosis in 2006 resulted in a brief resurgence in the use of bare metal stents (BMS), closer FDA examination revealed that both devices carry similar risk for thrombosis, and that DES, in fact, had other advantages over BMS. Over the past few years, DES technology has advanced with polymer construction, as well as improvements to the thickness/architecture, delivery systems, and the drug elution that coats the stent, collectively making DES superior to BMS today.
Drug-Eluting Stenting at Mount Sinai
Of all the percutaneous coronary interventions performed at the Mount Sinai Cardiac Catheterization Lab using stents in 2012, 94 percent were DES and six percent were BMS. With the use of DES, the risk of scar tissue formation within the stented area is 1-10 percent.
If restenosis should occur, Mount Sinai offers procedures to treat it. In 2012, Mount Sinai began performing intravascular brachytherapy (IVBT) for patients in which restenosis after the use of DES has occurred more than twice. In this procedure a catheter is threaded to the site, where it is held for a few minutes to administer a dose of radiation that will inhibit restenosis, and then it is retracted. Between July 2012 and November 2013, approximately 120 patients with DES in-stent restenosis have been treated with IVBT with only one complication.