Polymer-based paclitaxel-eluting coronary stents. Clinical results in de novo lesions.

Drug-eluting stents (DES) represent one of the fastest-growing fields in interventional cardiology today. Paclitaxel (Taxol) is a potent antiproliferative agent that shifts the microtubule equilibrium toward assembly, favoring the formation of abnormally stable microtubules with blockage of the cell cycle in G2/M phases. A series of clinical trials (TAXUS I through VI) have been designed to test the safety and the efficacy of polymer- based paclitaxel-eluting stents (Taxus, Boston Scientific, Natick, MA, USA) at the dosage 1 microg/mm(2) in a variety of clinical settings. Except for TAXUS III and TAXUS V-ISR, in the TAXUS program de novo lesions have been evaluated. Two different release kinetics were evaluated: slow-release (SR) and moderate- release (MR) formulation. Very encouraging preliminary results also come from the "real world" data on Taxus SR stent collected in the "Web-based taxus Intercontinental obServational Data TransitiOnal registry prograM" (the WISDOM Registry) and in the "Real Life Polymer-Based Paclitaxel Registry" (the Real Life PBPaclitaxel Registry). The remarkable positive results obtained from the randomized trials offer the interventional cardiologist another effective option (besides the Cypher stent, Cordis a J & J, Warren, NJ, USA) to treat patients with a DES. This fact may certainly drive the competition and, ultimately, lower the cost. The final answer will probably come from the ongoing registries and prospective trials versus coronary artery bypass grafting (CABG), which will reveal the real impact of this new technology on everyday practice.