Dr. Thierry Lefevre,
Innovations in stent technology (platform, polymers or no polymer, biodegradable or not…) with new stent generations as well as non stent based drug delivery is a heavily debated issue, which was discussed in a very well attended symposium.
Dr Chevalier from Massy, France, gave a summary of the polymer or non polymer technology available to date. He showed various technologies developed to avoid the potential late problems related to the presence of a durable polymer: bioabsorbable polymer already used with the Biomatrix or Nobori stent, mircroporous surface with no polymer or “reservoirs” created on the abluminal surface of the stent (Nevo stent). He showed very promising data with these second or third generation stents in terms of late loss and risk of late stent thrombosis. The advantage of abluminal delivery of the drug on the wall of the artery compared to global delivery was underlined. An interesting discussion came on the optimal duration of antiplatelet treatment after stenting with new generation stents, which should be shortened in the future in view of the absence of stent thrombosis in Spirit 3 with the Xience V stent (durable thin polymer) after stopping clopidogrel after 6 months. Dr Colombo from Colombus Hospital, Italy, gave a summary of the new stent platforms available to date. He showed nicely that new generation stents (mainly Xience, Biomatrix or Nobori stents) may decrease the risk of clinical restenosis without increasing the risk of late or very late stent thrombosis. This paradigm is very interesting, because the classical paradigm is that by increasing the antirestenotic effect, there is a higher risk that stent thrombosis may occur. The advantage of one drug versus another (Limus versus Paclitaxel) was also discussed and he found no advantage of using Paclitaxel, except in diabetic patients, where there is still some debate. An interesting discussion focused on the ideal trial (diabetic patients, all comers studies) design in 2010, regarding the very low rate of events with new generation stents. Dr. Smits from Rotterdam, Netherlands tried to answer to the difficult question: are second generation drug-eluting stents truly superior? He showed that the results are very promising, but a longer term follow-up is needed to be sure that there is no catch-up phenomenon. He showed very promising data with new generation stents with a durable polymer (Xience V), biodegradable polymers (Biomatrix, Nobori) or ‘reservoirs’ (Nevo) Finally, Dr Dudek from Krakow, Poland, gave an excellent summary of non stent based intracoronary drug delivery. He showed that many companies are developing a drug balloon delivery system and that the duration of drug delivery is crucial and subject to many parameters such as lipophily of the drug or solvant. Promising results were obtained for in-stent restenosis in a small PEPCAD randomised study and also in bifurcation lesions in the randomised study DEBIUT. He showed also that the use of a bare metal stent after drug balloon delivery does not guaranty the absence of stent thrombosis. He concluded that we need more data from larger randomised studies, and in daily practice, he uses this technology only for the treatment of in stent restenosis.
Innovation in stent technology
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