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From bare metal to barely anything: an update on coronary stenting
  1. Raffaele Piccolo,
  2. Anna Franzone,
  3. Stephan Windecker
  1. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Stephan Windecker, Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; stephan.windecker{at}insel.ch

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Learning objectives

  • To define the main components and features of new generation metallic drug-eluting stents and bioresorbable vascular scaffolds.

  • To learn about evidence from clinical trials that evaluated the performance of coronary stents.

  • To recognise unmet needs and future perspectives of coronary stent technology.

Introduction

In 2017, percutaneous coronary intervention (PCI) enters its 40th anniversary since the first description of balloon coronary angioplasty in a human by Andreas Gruntzig in 1977.1 Since then, the safety and efficacy of the procedure has steadily improved with continuous advances in the technique, equipment and procedural success. In the late 1980s, the advent of coronary stents favoured the widespread adoption of PCI in routine clinical practice by eliminating the risk of periprocedural abrupt closure related to coronary dissection and, as corollary, the need for standby emergent coronary artery bypass grafting (CABG). Nowadays, PCI constitutes the most commonly performed therapeutic procedure in cardiovascular medicine and one of the most frequent interventions performed in medicine.2 Unsurprisingly, three out of four patients requiring myocardial revascularisation are managed with PCI instead of CABG.3

Currently, new-generation drug-eluting stents (DES), featuring lower antiproliferative drug loads, thinner stent metallic struts and more biocompatible durable or biodegradable polymers than earlier devices, represent the standard of care among patients undergoing PCI.4 5 Three main categories of newer generation devices are used in clinical practice: permanent polymer DES, biodegradable polymer DES (BP-DES) and polymer-free DES (PF-DES).6 Bioresorbable vascular scaffolds (BRS) represent a further iteration in coronary device technology by affording a transient support to the coronary vessel for a variable period ranging from as short as 1 year to several years according to their composition.

This paper provides an overview of contemporary coronary devices, summarises the evidence from randomised trials and outlines future perspectives on coronary stent technology.

New-generation metallic DES

Despite the lack of a consensus definition, …

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