Zotarolimus for the treatment of coronary artery disease: pathophysiology, DES design, clinical evaluation and future perspective

BACKGROUND: Zotarolimus is an anti-proliferative drug used exclusively in the design of coronary drug eluting stent. OBJECTIVE: To review pathophysiological and clinical data regarding the use of zotarolimus-eluting stent (ZES) for the treatment of coronary artery disease. METHODS: Mechanism of action of zotarolimus is reviewed and design of different type of ZES described. Clinical results of the trials by the use of different ZES are discussed. RESULTS: First and second generations of ZES demonstrated to be safe but less effective in preventing restenosis as the competitive sirolimus eluting stent and paclitaxel eluting stent. Third generation of ZES that show new pharmacokinetic release of the drug may improve clinical results in continuing trials. CONCLUSIONS: Zotarolimus incorporated on stent platform represents a useful tool in treating patients with coronary artery disease. Release kinetic of the drug may play a major role in in-stent neointimal suppression during follow-up.