PCI Equipment: Stent Selection
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
- Drug eluting stent (DES) and bare metal stent (BMS are two main types of stents that are used during percutaneous coronary intervention (PCI).[1]
- Compared to the fist generation of DES, newer DES are optimized in drug, polymer, and stent design. This significant evolution in DES technology leads to lower rate of stent thrombosis and mortality rate.[2][3][4][5]
- Currently available DES is superior to both first-generation DES and BMS due to higher efficacy and safety and lower restenosis rates.[6][7][8][9]
- The following stents are listed from more safe to less safe based on several meta-analyses:[6][7][8][9]
- Durable-polymer DES
- Biodegradable-polymer DES
- BMS
ACA 2021 Revascularization Guideline
| Class 1 Recommendation, Level of Evidence: A[1] |
| DES is preferred over BMS in patients undergoing PCI to prevent restenosis, MI, or acute stent thrombosis. |
References
- ↑ 1.0 1.1 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ Bavry AA, Kumbhani DJ, Helton TJ, Borek PP, Mood GR, Bhatt DL (2006). "Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials". Am J Med. 119 (12): 1056–61. doi:10.1016/j.amjmed.2006.01.023. PMID 17145250.
- ↑ Lagerqvist B, James SK, Stenestrand U, Lindbäck J, Nilsson T, Wallentin L; et al. (2007). "Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden". N Engl J Med. 356 (10): 1009–19. doi:10.1056/NEJMoa067722. PMID 17296822.
- ↑ Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW (2005). "Late angiographic stent thrombosis (LAST) events with drug-eluting stents". J Am Coll Cardiol. 45 (12): 2088–92. doi:10.1016/j.jacc.2005.02.086. PMID 15963413.
- ↑ Nordmann AJ, Briel M, Bucher HC (2006). "Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis". Eur Heart J. 27 (23): 2784–814. doi:10.1093/eurheartj/ehl282. PMID 17020889. Review in: ACP J Club. 2007 May-Jun;146(3):66
- ↑ 6.0 6.1 Piccolo R, Bonaa KH, Efthimiou O, Varenne O, Baldo A, Urban P; et al. (2019). "Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials". Lancet. 393 (10190): 2503–2510. doi:10.1016/S0140-6736(19)30474-X. PMID 31056295.
- ↑ 7.0 7.1 Palmerini T, Benedetto U, Biondi-Zoccai G, Della Riva D, Bacchi-Reggiani L, Smits PC; et al. (2015). "Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis". J Am Coll Cardiol. 65 (23): 2496–507. doi:10.1016/j.jacc.2015.04.017. PMID 26065988.
- ↑ 8.0 8.1 Kang SH, Park KW, Kang DY, Lim WH, Park KT, Han JK; et al. (2014). "Biodegradable-polymer drug-eluting stents vs. bare metal stents vs. durable-polymer drug-eluting stents: a systematic review and Bayesian approach network meta-analysis". Eur Heart J. 35 (17): 1147–58. doi:10.1093/eurheartj/eht570. PMID 24459196.
- ↑ 9.0 9.1 Bangalore S, Toklu B, Amoroso N, Fusaro M, Kumar S, Hannan EL; et al. (2013). "Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis". BMJ. 347: f6625. doi:10.1136/bmj.f6625. PMC 3898413. PMID 24212107.