Stent selection to minimize the risk of stent thrombosis.

Abstract

Compared with bare metal stents (BMS), first-generation drug-eluting stents (DES) have significantly reduced the risk of ischemia-driven target vessel revascularization, but have been associated with an increased risk of very late (beyond 1 year) stent thrombosis. Second-generation DES have been developed using different platforms, alternative drugs, and either more biocompatible durable polymers or bioabsorbable polymers. In this review, we will analyze whether the improved technology of this new class of devices has improved their safety profile. Recent data accruing from frequentist and network meta-analysis have challenged the notion that DES are less safe than BMS. Several studies have in fact reported that cobalt-chromium everolimus-eluting stents (CoCr-EES) coated with durable fluorinated polymers may be associated with significantly lower rates of stent thrombosis not only compared with other first and second-generation DES, but also compared with BMS. In addition, four independent network meta-analyses have suggested that CoCr-EES may have a better safety profile than bioabsorbable polymer-based DES. Recent data from the last 2 years have suggested a paradigm shift from the notion that DES are less safe than BMS to the converse. Regarding this, the thin-strut CoCr-EES has consistently been associated with the lowest rates of stent thrombosis.