Insights on DES and LST from TCT 2006

TCT (Transcatheter Cardiovascular Therapeutics) in Washington tackled the issue of DES related late stent thrombosis head-on. There was a hotline set-up, just to take calls on late stent thrombosis (LST).

It is interesting to note that LST was an acceptable risk and complication of the use of Drug eluting stents. Dr Greg Stone presented the analysis of his experience with the clinical trials of the Taxus (paclitaxel eluting) stent. He noted that there was a 0.2-0.4%/year incidence of LST with the Taxus stent. He also saaid that there was an 0.2% incidence of death rate in those given bare metal stents, in their clinical trials.

What he is trying to say, I suppose, is that restenosis with bare metal stents is not benign. Patients can die from ischemia due to restenosis of bare metal stents. This incidence of death from bare metal stents seems almost equal the incidence of death from LST with DES. So the clinician/operator will have to make an important, informed choice, whenever he uses a DES. He is trying to lessen death from restenosis, but he may run the risk of death from LST.

In other words, as we have been saying all along, the use of the DES should be more selective and circumspect, not just because it is there. Well we will continue the ongoing TCT in Washington. I think that we should be hearing more on this subject.