Drug-eluting stents vs bioresorbable stents (scaffolds) vs drug-eluting balloons: the advantages and drawbacks of new technologies.

Abstract

2016;11(3-4):124. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloskih medicinskih sestara i tehnicara The introduction of bare-metal stents (BMS) significantly advanced the field of interventional cardiology by reducing the number of reinterventions. In order to reduce restenosis, drug-eluting stents (DES) were developed, and are further differentiated by stent platform, polymer type, and active substance. The first generation of DES, paclitaxel-eluting stents (PES) and sirolimus-eluting stents, are no longer used as the second generation of stents are superior: zotarolimus-eluting stents (ZES) and everolimuseluting stents (EES). They are biocompatible, cause less inflammatory reactions, and become covered with endothelium more quickly. Resolute zotarolimus-eluting stents (R-ZES) and EES are comparable, and are superior in relation to other DES’s. Meta-analyses of studies have proven DESs with bioresorbable polymer (biolimus and sirolimus) superior to 1st generation DESs (sirolimus) in their reduced revascularisation of target veins and reduced incidence of in-stent thrombosis in a 5-year period. However, if these stents are compared with the new generation of DESs, it becomes clear that the percentage of target vessel reintervention is comparable. DESs with resorbable polymer are comparable to R-ZES in their incidence of in-stent thrombosis and mortality rates, while they are inferior to EES. It is difficult to design a non-polymer DES due to problems in attaining a stable concentration of anti-proliferation drug necessary to prevent neointimal hyperplasia. The first studies are promising, and have shown no significant differences in the later loss of lumens, angiographic restenosis, or revascularization of target veins due to restenosis as compared to a standard DES with paclitaxel. The time necessary to release this drug is one month, and its application would reduce the length of dual antiplatelet therapy, thus completely eliminating rare indications for the application of BMS.1-3