A drug-eluting stent (DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly release a drug to block cell proliferation. This prevents fibrosis that, together with clots (thrombi), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the peripheral or coronary artery by an interventional cardiologist or interventional radiologist during an angioplasty procedure. Drug-eluting stents in current clinical use were approved by the FDA after clinical trials showed they were statistically superior to bare-metal stents for the treatment of native coronary artery narrowings, having lower rates of major adverse cardiac events (usually defined as a composite clinical endpoint of death + myocardial infarction + repeat intervention because of restenosis). The first drug-eluting stents to be approved in Europe and the U.S. were coated with paclitaxel or an mTOR inhibitor, such as sirolimus. Indications Considerations for use It is crucial to identify patients who are good candidates for procedural intervention. Generally, patients without symptoms of coronary blockage or without evidence of ischemia (oxygen deprivation) on labs and imaging are not subjected to stent procedures, as the complications and risks of such a procedure would outweigh any potential benefit. Procedural intervention, such as angioplasty or stent placement, is reserved for patients with clinical symptoms of coronary artery flow reduction or observable coronary artery obstruction on imaging. This is otherwise known as a myocardial infarction (heart attack). These symptoms can include, but are not limited to: Severe, pressure-like chest pain unrelieved by rest Shortness of breath, fatigue, lightheadedness Palpitations Atypical symptoms: nausea, vomiting, indigestion, confusion, back pain There are two major classifications of myocardial infarction (MI): ST-elevation MI vs. non-ST elevation. The criteria for diagnosis are beyond the scope of this article, but it is important to note that stenting is considered first-line therapy for patients diagnosed with a STEMI. Contraindications The only absolute contraindication to stent placement is significant active bleeding. This is due primarily to the need for in-procedure anticoagulation and dual antiplatelet therapy during the recovery period. Other considerations that could prevent the use of stents include a history of in-stent restenosis, bleeding diathesis (high susceptibility to bleed), complex or unsuitable coronary anatomy, and/or a short life expectancy due to other medical conditions. Off-label use Drug-eluting stents also have been shown to be superior to bare-metal stents in reducing short-term complications of stenting in