Ongoing Late Lumen Loss with the CYPHER and TAXUS Drug-eluting Stents Supports a Theory of Catch-up Restenosis

Luminal loss and restenosis are critical problems in coronary artery drug-eluting stents (DES). These implants need to minimise long-term neointimal coverage and maximise blood flow. Two studies compared the effects of different types of DES on lumen loss after surgical implantation. The first study included 2,030 patients and showed that over two years late luminal loss (termed ‘late luminal creep’) progressed for two types of commercially prepared permanent polymer stents containing rapamycin or paclitaxel (CYPHER and TAXUS), but not for a polymer-free in-house coated stent containing rapamycin (YUKON). In a smaller study, luminal coverage was lower with the CYPHER than with the YUKON stent, but struts of the stent structure were better covered with the YUKON stent and less likely to cause an obstruction. Stents should ideally limit luminal loss but also allow for sufficient coverage to prevent thrombotic hazards.