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Implantation of bare-metal stents (BMS) in the early 1990s was a milestone in the development of interventional cardiology.1 Stents provided benefits compared with balloon angioplasty alone by reducing the risk of acute vessel occlusion and recurrent ischaemia, and by optimising acute lumen gain and preventing early vessel recoil. A decade later the implementation of drug-eluting stents (DES) has further improved clinical outcomes mainly by substantially reducing restenosis, the Achilles′ heel of BMS. However, because of impaired vascular healing, there was a higher risk of late and very late stent thrombosis (ST) associated with the first-generation DES when compared with BMS. ST is a potentially catastrophic event so the widespread perception that BMS may be safer than DES was initiated and, as a consequence, the frequency of DES implantations substantially decreased around the world.
To overcome the safety concerns of the first-generation DES, newer devices have been developed with new stent platforms and designs, with more biocompatible polymers or without polymers and with new antiproliferative agents. The outcomes after implantation of the second-generation DES have been much better in comparison to BMS and the first-generation DES in terms of efficacy and safety.2 The results achieved with the new-generation DES are so convincing that in a recent review published in the European Heart Journal, the authors conclude: “We suggest that BMS should be honourably retired and added to the history books (…)”.3 They also cite a …
Contributors PK is the first author with a mentorship, corrections and final approval by KR.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.