David E. Kandzari

Despite considerable benefits associated with current drug‐eluting stents (DES), continued attention to the safety, efficacy, and deliverability of first‐generation DES has led to the development of new antiproliferative agents with alternative stent platforms and different drug carrier systems. Zotarolimus is a recently developed pharmacologic agent with both antiproliferative and anti‐inflammatory properties. The Endeavor drugeluting stent (Medtronic Vascular, Santa Rosa, CA) represents the combination of zotarolimus, a low‐profile cobalt alloy stent platform, and a biocompatible phosphorylcholine drug carrier system. At present, four clinical trials examining the safety and efficacy of the Endeavor stent have been performed. Although these studies have enrolled patients with similar clinical and angiographic characteristics, they have differed in trial design and study population size and have been performed across a broad geographic and physician distribution. Despite these differences, the results of these trials demonstrate consistently low rates of angiographic restenosis and repeat revascularization in addition to a favorable safety profile, with no occurrences of late stent thrombosis through 1 year of follow‐up. This review describes the pharmacology and design on the Endeavor stent, summarizes results from recent clinical trials evaluating the Endeavor stent, and provides an overview of ongoing and future directions for clinical investigation.

Purpose: To determine midterm clinical outcomes among patients with lower extremity peripheral arterial disease who underwent revascularization with catheter-ba...

We examined outcomes of clinical restenosis and temporal trends in repeat target vessel revascularization (TVR) among a broad, unselected patient population undergoing percutaneous coronary revascularization. The extent to which clinical trials involving protocol-specified follow-up angiography reflect real-world practice where interventions are driven by clinical restenosis is not completely understood. Whether clinical outcomes have varied over a long-term period that has paralleled substantial advances in stent design, balloon delivery catheter and adjunctive pharmacologic therapies is uncertain. To characterize the effectiveness of coronary stenting in routine practice, we examined 1-year clinical outcomes of death and repeat TVR among 5,765 patients enrolled in the Duke Database for Cardiovascular Disease who underwent stent placement between 1994 and 2002. To assess for temporal trends in outcomes, patients were further divided into tertiles according to the year of initial revascularization. Overall, the 1-year occurrence of TVR and death was 11.4% and 4.9%, respectively. Rates of repeat TVR increased at 3-month intervals, with most events occurring prior to 9 months. In an adjusted analysis over an 8-year period, 1-year survival did not significantly differ across patient tertiles (p = 0.95), although rates of recurrent TVR significantly decreased (1994-1996, 11.1%; 1997-1999, 11.5%; 2000-2002, 9.3%; p = 0.003). In a broad patient population in whom repeat angiography is not protocol-specified, most events occur within the initial months following revascularization, yet late clinical restenosis continues. Although survival has not improved since the introduction of coronary stents, overall rates of repeat revascularization have modestly, but significantly, declined.

Purpose: To examine the safety and efficacy of catheter-based plaque excision as an alternative therapy to surgery, conventional angioplasty, and/or stenting in...

Even in the absence of symptoms, peripheral arterial disease carries with it a significant risk of morbidity and mortality; thus, screening with the use of the ankle-brachial index is important in identifying patients at risk. Endovascular therapy in the lower extremities is continually evolving for treatment of patients with claudication symptoms or limb-threatening ischemia. Alternative treatments such as cryotherapy and the use of laser-assisted angioplasty hold much promise but need further investigation. In the case of renal artery stenosis and resulting hypertension, supportive clinical evidence is limited for renal revascularization despite the rationale for reducing cardiovascular risk. The current standard of care for significant carotid artery stenosis can include carotid stenting and carotid endarterectomy, but medical therapy may have a role also.