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Everything You Need to Know About Drug-Eluting Stents (DES)

What They're Made Of

Typically, stents are made of a metal mesh "skeleton." They can be collapsed and expanded. To make a drug-eluting stent, stents may be coated with special polymers that contain the drug, although some drugs can be bonded directly to the metal stent without a polymer. 
 
Which drugs are used in drug-eluting stents? A few different ones are used, such as sirolimus, paclitaxel, everolimus, and zotarolimus. These drugs work in different ways, but they all work to help prevent renarrowing of the artery.
 
The problem with these drugs is that they are often highly toxic and cause a whole host of dangerous side effects if taken by mouth or IV. Part of the reason why drug-eluting stents are so ingenious is that they allow the drug to be delivered exactly where it is needed without exposing the whole body to toxic levels of these substances.
 

Are Drug-Eluting Stents Better?

The billion-dollar question is whether the new drug-eluting stents are better than the old bare-metal ones. The research pretty clearly shows that drug-eluting stents are, in general, better at preventing restenosis compared to bare-metal ones.
 
However, it's important to evaluate drug-eluting stents on a product-by-product basis. There are significant differences among the products (different stent structures, different drugs, different polymers, etc.), and some appear to be much better than others.
 
There has been quite a bit of concern about the possibly increased risk of clot formation (which can cause heart attack and even death) with drug-eluting stents, compared to bare-metal stents. Because drug-eluting stents delay the normal process of healing over the stent, they may be more susceptible to clots, since clots tend to form on foreign materials. This is a hotly debated topic, with many arguing that the small increase in clots is overshadowed by the larger benefit of reduced renarrowing that drug-eluting stents provide.
 
It appears that drug-eluting stents may be better for some people, such as those at high risk for restenosis and those who will be faithful in taking their clot-preventing medications, but not for others, such as those with a low risk for restenosis and those who will likely not take their clot-preventing medications consistently.
 
However, it appears that newer, "next generation" drug-eluting stents might make the choice among stents an easier one, as some research suggests that they might be able to provide the best of both worlds, with both a lower risk of renarrowing and a reduced risk of clots.
 
Life After a Stent: 5 Realistic Ways to Take Charge of Your Health

Coronary Stent Information

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