Los stents recubiertos de fármacos (SRF) permiten el aporte intravascular local de elevadas concentraciones de un agente antiproliferativo en el lugar de la lesión, para inhibir la neoproliferación excesiva de la íntima, al mismo tiempo que se minimizan los efectos secundarios sistémicos del fármaco. Los ensayos fundamentales SIRIUS y TAXUS IV, multicéntricos, prospectivos, de distribución aleatoria y a gran escala, aportaron pruebas convincentes de que los SRF disminuyen de manera significativa la reestenosis y los fenómenos clínicos que la acompañan, en comparación con los stents de metal desnudo (SMD), después del implante en lesiones relativamente simples y moderadamente complejas en las arterias coronarias nativas. Otros estudios posteriores se han centrado en valorar la seguridad y la eficacia de los SRF en lesiones más complejas, incluidas las lesiones en los vasos de pequeño calibre y las lesiones largas, ambas con unas tasas de reestenosis más elevadas que las lesiones no complejas cuando se tratan mediante angioplastia con balón o SMD. En la presente revisión se resumen las pruebas actuales, obtenidas en ensayos de distribución aleatoria, registros prospectivos y estudios de observación, sobre la seguridad y la eficacia de los stents recubiertos de paclitaxel o sirolimus en las lesiones complejas, excluidas o poco representativas en los principales ensayos anteriores, y se enfoca sobre el tratamiento de las lesiones largas (incluidas las que requieren stents múltiples) y las localizadas en los vasos de pequeño calibre.
Palabras clave
Stent
Lesión
Coronariopatía
Reestenosis
Pronóstico
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