From bare metal to barely anything: an update on coronary stenting

Biodegradable vs. permanent polymer drug-eluting stents: the need for a new nomenclature to classify drug-eluting stent technology

“…Newer generation DES involve advancements in all three components of DES-the metallic platform, the polymer coating, and the antiproliferative drug (Take home figure). 1 Principal iterations in metallic stent platforms comprised the replacement of stainless steel by cobalt chromium or platinum chromium alloys and changes in stent architecture allowing for a reduction in strut thickness to 60-80 lm while maintaining radial strength, reducing strut-related alterations in shear stress, and facilitating more rapid and complete endothelial strut coverage. By far most efforts were put into iterations of the polymer coating.…”

Communicating with our patients for shared decision making

“…The Education in Heart article9 in this issue provides a quick overview of new-generation coronary stents with the three main categories being permanent polymer drug-eluting stent (DES), biodegradable polymer DES and polymer-free DES. The antiproliferative drug used in stents now mainly are analogues of rapamycin which induce a reversible arrest of the cell cycle with a broader therapeutic window than previous agents.…”

Novel treatments for in-stent restenosis: sirolimus-eluting balloons enter the arena

“…As first iteration in PCI, balloon angioplasty presented several drawbacks, including intimal and media dissection, abrupt vessel occlusion, late structural remodeling and, importantly, diffuse proliferative neointimal response due to traumatic vessel injury, resulting in a rate of restenosis greater than 40% (2). The introduction of coronary stents substantially improved procedural success and clinical outcomes after PCI by significantly reducing the risk of restenosis and nearly eliminating the risk of acute vessel closure with the consequent need for surgical standby (2). However, the lack of antiproliferative drug release from bare metallic platforms remained associated with higher rates of ISR and target vessel revascularization.…”