Stents recubiertos de fármacos para el tratamiento de lesiones complejas: Enfoque sobre las lesiones largas y los pequeños vasos

Drug-eluting stents enable high concentrations of antiproliferative agents to be delivered intravascularly close to the lesion site, thereby inhibiting excessive neointimal proliferation while simultaneously minimizing the systemic side effects of the drug. The groundbreaking SIRIUS and TAXUS IV trials were large-scale, prospective, multicenter randomized studies which provided convincing evidence that drug-eluting stents significantly reduce the rates of both restenosis and associated clinical events compared with bare metal stents when they are implanted into relatively simple or moderately complex lesions in native coronary arteries. Subsequent studies have been designed to assess the safety and efficacy of drug-eluting stents in more complex lesions, such as those in small-caliber vessels and long lesions, both of which are known to have higher restenosis rates than uncomplicated lesions when treated with either balloon angioplasty or bare metal stents. This review summarizes current findings from randomized trials, prospective registries, and observational studies on the safety and efficacy of paclitaxel-eluting and sirolimus-eluting stents in complex lesions, which were either excluded from or underrepresented in previous large trials, and focuses on the treatment of long lesions (including those that require multiple stents) and on lesions located in small-caliber vessels.