Stent, drug-eluting stent, DES

Stent is a tiny metallic mesh tube used to expand and keep a diseased coronary artery open. Stent insertion or stenting is a part of PCI, percutaneous coronary intervention or angioplasty for coronary artery disease.

Previously used bare metal stents (BMS) are now largely superseded by drug eluting stents (DES) which are coated with certain medication to avoid restenosis, recurrence of narrowing of the coronary artery. Restenosis was part of exaggerated healing process with overgrowth of the lining of the coronary artery causing reduction in diameter of the artery, impairment of the blood flow and thus recurrence of angina. Restenosis appeared in patients treated with BMS in up to 30% whereas in DES the rate of restenosis is about 10%.

The drugs used in DES have immunosuppressive effects but are safe without systemic side effects because of the local delivery inside the coronary artery. Most drug eluting stents use paclitaxel or ‘limus’ drugs such as sirolimus, everolimus and zotarolimus.

Stents, particularly drug eluting stents require use of blood thinning medication in the form of aspirin and clopidogrel, prasugrel or ticagrelor (DAP, dual antiplatelet medication) to prevent risk of blood clots within the stent which would lead to sudden obstruction of the coronary artery and massive heart attack. The use of these drugs is absolutely mandatory for the period prescribed by your cardiologist.

  • Aspirin 75mg daily for life AND
  • Clopidogrel 75mg daily OR Prasugrel 10mg daily OR Ticagrelor 90mg twice daily for 12 months following stent insertion

These drugs must never be prematurely stopped or interrupted without prior consultation with cardiologist.