Bioabsorbable drug eluting stent: winner or sinner?BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7091 (Published 27 November 2013) Cite this as: BMJ 2013;347:f7091
- Pascal Meier, consultant cardiologist
- 1The Heart Hospital, University College London Hospitals UCLH, London W1G 8PH, UK and Yale Medical School, New Haven, CT, USA
In pooled analyses of randomised trials, two linked papers (doi:10.1136/bmj.f6625; doi:10.1136/bmj.f6530) compare intracoronary stents, with a particular focus on the latest development—drug eluting stents with biodegradable polymer.1 2 The development of bare metal coronary stents in 1986 was a milestone in the treatment of coronary artery disease. It overcame serious limitations of plain balloon angioplasty, such as high rates of restenosis, vessel recoil, and impaired coronary flow owing to local dissections. However, these stents were associated with a high risk of restenosis—10-20%.3 The introduction of drug coated stents, using antimitotic agents, reduced the restenosis rate by about half.3 First generation drug eluting stent became available in 2003.
After the initial excitement, however, studies showed worrying signals of an increased risk of stent thrombosis for drug eluting stents, especially late events. Antimitotic drugs can impair the re-endothelialisation of the stent,4 and late stent thromboses may be related to the polymer used to attach the drug to the stent (possibly an allergic reaction). Drug eluting stents with a bioabsorbable polymer were therefore developed with the aim that once all the antimitotic drug had been released and the …