Drug-Eluting Stents: Das Ende einer Erfolgsstory?

Drug-eluting Stents (= medikamentenbeschichtete Stents) haben Anfang dieses Jahrhunderts die invasive Kardiologie revolutioniert, indem durch die kontrollierte Abgabe von Medikamenten die Narbenbildung bzw. Proliferation der glatten Gefäßmuskelzellen nach Koronarintervention verhindert oder mindestens stark gebremst werden konnte [1] [2]. Als Medikamente wurden immunsuppressive oder antimitotisch wirkende Substanzen (Rapamycin oder Paclitaxel) eingesetzt, da anhand von Tierversuchen eine erfolgreiche Reduktion der Intimaproliferation [3] [4] mit diesen Substanzen gezeigt werden konnte (Tab. [1]). Durch das Aufbringen einer Trägersubstanz (meist Polymer) und der Medikamente verlor der Stent allerdings seine glatte Oberfläche und wurde dadurch thrombogener, was bei Patienten mit aktiviertem Gerinnungssystem bei akutem Koronarsyndrom gelegentlich zu Problemen führte [5].

Tabelle 1 Auswahl von CE-zertifizierten medikamentenbeschichteten Stents Stentname Wirksubstanz Trägersubstanz Cypher Sirolimus Polymer Taxus Paclitaxel Polymer Endeavor Zotarolimus Phosphorylcholin Xience/Promus Everolimus degradierbares Polymer Janus Tacrolimus Carbofilm Taxcor Paclitaxel Biopolymer CoStar* Paclitaxel Polylactid * 2007 vom Markt genommen

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