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Biodegradable-polymer drug-eluting stents: back to the future?
  1. Salvatore Cassese1,
  2. Erion Xhepa1,
  3. Adnan Kastrati1,2
  1. 1Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
  2. 2DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
  1. Correspondence to Dr Salvatore Cassese, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich 80636, Germany; cassese{at}dhm.mhn.de

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Supportive backbones, polymer coatings or carriers and antirestenotic drugs contribute to the efficacy and safety of drug-eluting stents (DESs). In particular, the combination of polymer carriers with active drugs (the so-called ‘matrix’) has a main role in the performance of a DES. A polymer coating should ideally regulate drug-release kinetics without further interaction with the vasculature. In contrast, some polymer coatings persist in the implanted vessel wall long after their useful function has been served. These non-erodable or durable polymers may elicit a chronic inflammatory response at the site of stent implantation with possible neoatherosclerosis and stent thrombosis (ST) over the long term.

Biodegradable-polymer DESs are regarded as alternative to durable-polymer DESs. Indeed, once the active drug is eluted and the polymer coating degraded, the remaining stent backbone resembles that of a bare metal stent. In virtue of the biodegradable nature of the polymer coating, the ambitious goal of this technology is to reduce the risk for ST and the need for prolonged antiplatelet therapy compared with earlier DES platforms. Clinical investigations displayed that in comparison with early generation DESs, those stents eluting antirestenotic drugs from a biodegradable polymer have superior long-term safety and efficacy. In contrast, the potential advantages of these platforms versus new-generation durable-polymer DESs appear less obvious.

In the era …

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