Coronary stent healing, endothelialisation and the role of co-medication

Since the second half of 2006 percutaneous coronary revascularisation using drug-eluting stents (DES) has come under the scrutiny of the general cardiology community. The initial favourable reports and publications on the merits of DES suddenly changed due to more or less qualified new data on complications such as late stent thrombosis. It seems that the commotion about late stent thrombosis has been over-emphasised, considering the publications that followed from the randomised controlled trials published together in one issue of the New England Journal of Medicine earlier this year.1 The main message from these publications was that indeed late stent thrombosis occurred, but also in the bare metal stent (BMS) groups. However, the debate was further fuelled by data showing that in pathological specimens from autopsy studies more fibrinoid and less endothelialisation could be demonstrated in DES.