Bare metal stent or drug-eluting coronary artery stent. How to choose the best stent? 9
Coronary artery stent technology rapidly evolves. When a patient should still get a bare metal stent instead of drug-eluting coronary stent? Limits to anticoagulation therapy, other pending procedures, and diameter of coronary artery to be stented all factor in. Use of drug-eluting coronary artery stents or bare-metal stents is controversial. Dr. Anton Titov, MD. In which coronary artery disease situations the bare metal stents might be enough? Dr. Anton Titov, MD. In which situations the drug-eluting coronary artery stents are preferable? Dr. Jeffrey Popma, MD. Yes. The answer to the question about whether one should use drug-eluting coronary stents or bare metal stents is one that has a time component to it. At what time of the cycle of our stent development is that true? There were once the early days of coronary artery stent development. Dr. Jeffrey Popma, MD. We had two stents, the Taxus and Cypher stents. Both of those stents had polymers on their surface that were inflammatory. As a result of that we had to have long-term dual antiplatelet therapy that we had to give. We worried for a very high frequency of late stent thrombosis, after a year. After the patients will be off their dual antiplatelet therapy. So in coronary artery stent cases we were limited by how long we could give the dual antiplatelet therapy. Dr. Jeffrey Popma, MD. We were always afraid of stopping it. In those circumstances patients might get bare metal stents rather than drug-eluting stents. It was done to avoid the potential bleeding or stent thrombosis when the patient came off therapy. Dr. Anton Titov, MD. Well, that was coronary artery stents in the 2003 – 2004 timeframe. Today the equipment is much different. Dr. Jeffrey Popma, MD. The coronary stent struts are much thinner. The polymers are much thinner. The polymers are now more biocompatible. At least in our current method of thinking. The occurrence of coronary stent thrombosis may be as good or even a little less now. We use the drug-eluting coronary artery stents. Dr. Jeffrey Popma, MD. This is compared to the bare metal stents. Now I really limit my bare metal stent use to patients who have two millimeter vessels or smaller. We don’t have drug-eluting stents in that area. We will have very narrow lumen drug-eluting stents soon. But I don’t have them now. Or in patients who I know within the next month are going to have to go off to surgery of some sort. Dr. Anton Titov, MD. They can only be on dual antiplatelet therapy for a month. Where we are in a grey zone is now is here. We have some other clinical trials that are ongoing right now in patients with the coronary artery Synergy stent. Dr. Jeffrey Popma, MD. This coronary artery stent has a bio-resorbable polymer that disappears over 90 days along with the medications. The medications is eluted from the stent. We are exploring the idea in a registry series whether or not we can stop the antiplatelet therapy at 90 days in those patients. We hope patients stay without the risk of stent thrombosis. Because at 90 days all that is left is a metal stent. Dr. Anton Titov, MD. This is certainly an evolving concept. Dr. Jeffrey Popma, MD. I would say my drug-eluting coronary artery stent use is 95%. In 5% when I might be using bare metal stents, I have to have a good reason for using a bare metal coronary artery stents.
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