Importance of Short-Term Neointimal Coverage of Drug-Eluting Stents in the Duration of Dual Antiplatelet Therapy

TL;DR

This paper reviews how quickly drug-eluting stents are covered by tissue and how that affects how long patients should take dual antiplatelet therapy.

Contribution

It provides a synthesis of evidence linking early neointimal coverage of stents to the safety of shortening dual antiplatelet therapy duration.

Findings

Histological and OCT studies show 83.2% strut coverage at one month and 93.3% at three months.

Short-term DAPT (1 month) is safe for high-bleeding-risk patients.

Three-month DAPT is effective and safe in a broader patient population.

Abstract

Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation, but optimal DAPT duration remains a topic of intense discussion. The shorter regimen of DAPT might be especially beneficial for high-bleeding-risk (HBR) patients. Novel stent platforms have been designed with innovations that should facilitate vessel healing following stent implantation and enable short DAPT. This review aimed to summarize evidence of the neointimal coverage of short-term stents and their implications for DAPT duration. Results from histological and optical coherence tomography (OCT) studies confirm the significant role of uncovered struts after the implantation of a stent in patients presenting with late stent thrombosis. Several studies have shown favorable vessel healing at one month (with 83.2% of covered struts, on average) and three months following stent implantation (with 93.3% of covered struts, on average). Solely HBR patient trials have proven that one month of DAPT can be applicable and safe in this population. Three-month DAPT was tested in a more diverse population and remains effective and safe in comparison to a longer DAPT regimen. That evidence proves that short-term DAPT might be applicable, especially for HBR patients.

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