The quest for a 'better mousetrap'

Abstract

Percutaneous coronary intervention has been limited by the diminution of acute luminal gain over time. The limitations of conventional balloon angioplasty spawned a variety of different devices, all with the hope of identifying a device that would durably preserve acute luminal gains with an excellent safety profile. To date, the evolutionary victor in this search appears to be the drug-eluting stent. Commercially available drug-eluting stents have demonstrated durable long-term results.1 Despite this, questions concerning both the long-term efficacy and safety of drug-eluting stents have persisted, be it catch up restenosis or late stent thrombosis.2 Thus, the quest for the ideal device continues. Byrne and colleagues report a randomized trial of three limus agent-eluting stents with biodegradable or permanent polymer coating (the ISAR-TEST-4 Study).3 This study of >2600 patients is the largest randomized trial of a biodegradable polymer-based drug-eluting stent to date, and compares a novel biodegradable polymer-based, rapamycin-eluting stent with the two leading limus-based drug-eluting stents, sirolimus (Cypher) and everolimus (Xience). As such, it builds on the experience of other major randomized trials, observational studies, and registries utilizing biodegradable polymer-based drug-eluting stents.2,4–6 Combined, this provides an expanding platform by which to study and develop what may potentially prove to be the next iteration of coronary drug-eluting stent technology. The appeal of a biodegradable polymer drug-eluting stent is readily evident. Drug-eluting stents were developed utilizing antiproliferative agents to inhibit the neoimtimal hyperplasia that results from bare …