New drug-eluting stents: technological refinement continues

Abstract

The arrival of drug-eluting stents (DES) nearly 2 decades ago ignited a revolution in the field of interventional cardiology. The addition of antiproliferative drugs to the stent platform reduced the rate of in-stent restenosis significantly and increased the number of patients that, to this date, have benefited from percutaneous revascularization.1,2 However, its Achilles tendon was initially the higher rate of late stent thrombosis involved. The permanent polymer used in the first generation of DES induced inflammatory and hypersensitivity reactions that delayed endothelization. A health alert followed3 that made the medical community recommend extended courses of dual antiplatelet therapy and put into question the convenience of DES. Beyond the increased rate of stent thrombosis, the first-generation of this type of stents had additional limitations: they were stainless-steel platforms with up to 140 µm thick struts, worse stent navigability, and fewer crossing capabilities. Also, the stent maximum expansion was limited (3.5 mm in the Cypher stent, Cordis Corp.), which occasionally prevented treating left main coronary artery lesions. With the passing of time, this stent technology has been refined to a point that there has been a major overhaul in its 3 main components: platform, polymer, and antiproliferative drug. The changes made to the...