ABSTRACT
Percutaneous coronary intervention (PCI) has evolved since the first metal devices were implanted into coronary arteries in the late 1980s. These initial self-expanding devices were quickly replaced by balloon-expandable bare-metal stents (BMS) and then at the turn of the twenty-first century by drug-eluting stents (DES). The consistent benefits observed with DES over BMS in randomised and observational studies in all arrays of patient and lesion types have established that coronary stents should elute an anti-proliferative drug, whose purpose is to limit neointimal proliferation. Pre-clinical data exist to suggest that everolimus, sirolimus and zotarolimus have a comparable ability to suppress neointimal hyperplasia when controlling for stent platform, polymer, drug load and drug release kinetics. The time-dependent need for stent polymers has led to the development of DES with biodegradable polymers. These devices offer the functions of a conventional DES at the time of deployment, whilst following polymer breakdown they offer the long-term safety benefits of a BMS.
