Backgroundvery late stent thrombosis vlst was reported to occur even in patients with bare metal stent bms implantation, although the annual incidence. There are currently five types of stents available. Rebel stent has the visibility you want from its ptcr alloy, the strength you need with the lowest recoil and greatest radial strength, and the outstanding deliverability you expect from the boston scientific family of stents. In an ideal setting, a coronary stent should be highly deliverable, owing to a thin strut and lowprofile flexible design, while providing appropriate radial strength, nearabsent recoil, and high. Drug eluting stent des bare metal stent bms dual therapy stent. Percutaneous coronary intervention pci with implantation of drugeluting or baremetal stents has become one of the most frequently performed therapeutic procedures in medicine.
Bare metal stent is a type of stent which does not contain any coating or covering. Although drugeluting stents des have drastically reduced the incidence of isr, treatment of desisr is particularly challenging. Drugeluting stents versus baremetal stents in acute. Category baremetal stents, coronary device details currently available baremetal coronary stents include the following see. Methods and results we performed a metaanalysis of eight randomized trials comparing drugeluting stents sirolimuseluting or paclitaxeleluting stents with baremetal stents in 2786 patients with. Pdf covered versus baremetal stents for iliac occlusive. Objective to determine the costeffectiveness of drugeluting stents des compared with bare metal stents bms in patients requiring a percutaneous coronary intervention in france, using a recent metaanalysis including secondgeneration des. Freedom from occlusion was also higher in lesions treated with covered stents than in those treated with a baremetal stent hr, 0. Drugeluting or baremetal stents for acute myocardial. Limited data are available on the longterm effects of contemporary drugeluting stents versus.
Methods a total of 783 patients with ami and cs undergoing early revascularisation were. Veriflex bare metal coronary stent system is a product of boston scientific corporation. The rebel stent system is the newest advance in bare metal stent technology. Outcomes of covered versus baremetal balloonexpandable. Clinical utility of platinum chromium baremetal stents in. How the safety profile of newgeneration des compares with that of baremetal stents bms is less clear. Drugeluting or baremetal stents for coronary artery. Drugeluting stents versus bare metal stents for percutaneous coronary intervention in kidney transplant recipients. For those who need a baremetal option, the rebel stent is a clear choice. Drugeluting stents des are associated with a decreased frequency of repeat revascularization compared with bare metal stents bms in patients with coronary artery disease.
Zes with a unique drug fastrelease profile versus baremetal stents bms under similar durations of dualantiplatelet therapy dapt. Baremetal stents are better for some heart patients date. The introduction of baremetal stents bms has represented a major advancement over plain old balloon angioplasty in the management of. Stents not coated with drugs are called bare metal stents. Baremetal coronary artery stents are used in percutaneous coronary intervention pci for a variety of indications, including stable and unstable angina, acute myocardial infarction mi, and multiplevessel disease. Raising the standard for baremetal stents raising the standard for baremetal stents 11276000en rev. Drug eluting stents versus bare metal stents for the. Objectives the aim of the present study was to assess the outcome of patients with acute myocardial infarction ami complicated by cardiogenic shock cs receiving drugeluting stents des compared with baremetal stents bms. The deployment of baremetal stents bmss can overcome these problems and achieve a better patency rate than simple balloon angioplasty.
Not every patient is a candidate for drugeluting stents. Methods and results comparative des versus bms studies published or presented through february 2008 with 100. After experiencing encouraging results with des, we sought to compare outcomes of bms and des in native and post. Essentially expandable mesh cylinders, they are mounted on a balloon and open out once inside the coronary artery to line the wall. Drugeluting stents versus bare metal stents for percutaneous. Pdf ultrathin strut cobalt chromium bare metal stent usage in a. Aortoiliac lesions treated with a covered stent were significantly more likely to remain free from binary restenosis than those that were treated with a baremetal stent hazard ratio hr, 0. Background while a growing number of reports offer evidence for the potential of drug eluting stents des in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared with bare metal stents bms is uncertain due to the lack of a large prospective randomized trial. Gregg stone from columbia university medical center, new york, ny moderated the topic drugeluting versus baremetal stents with drs.
Percutaneous coronary intervention pci with implantation of drugeluting or bare metal stents has become one of the most frequently performed therapeutic procedures in medicine. Isr mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Management of patients with instent restenosis isr remains an important clinical problem. If you are a subscriber or member, click the login link or the subscribe link in the top menu above to access this article. The introduction of baremetal stents bms has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. The platinum chromium ptcr bms in the omega trial had only 7. Zotarolimuseluting versus baremetal stents in uncertain. The metaanalysis did not show a significant difference in primary patency at 1, 2, and 3 to 5 years for covered stents compared with baremetal stents 91. G to i histologic section from a 47yearold male who had a bare metal stents bms implanted 8 years prior to death case 8 in table 4.
Although they almost eliminated the risk of the artery collapsing, they only modestly reduced the risk of renarrowing. Should we still have baremetal stents available in our. Although they almost eliminated the risk of the artery. The first stents licensed for use in cardiac arteries were bare metal often 316l stainless steel. Benefits and harms of drugeluting versus baremetal. Dual therapy stent dts is the latest type of coronary stent.
To compare the efficacy and safety of drugeluting stents vs. Objective to determine the costeffectiveness of drugeluting stents des compared with baremetal stents bms in patients requiring a percutaneous coronary intervention in france, using a recent metaanalysis including secondgeneration des. Eight years later, the fda approved the first heart stent for use in the u. Before and after circulation, measurement of various inflammation and coagulation markers and scanning electron microscopy were performed. The absolute risk of a serious adverse event was 18. Costeffectiveness of drugeluting stents versus bare. Metaanalysis of randomized trials on drugeluting stents. Longterm outcomes with drugeluting stents versus bare metal stents in the treatment of saphenous vein graft disease results from the registro regionale angioplastiche emiliaromagna registry. Comparison of outcomes using bare metal bms and drug. Baremetal stents are better for some heart patients.
Esrd patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stentrelated complications including major adverse cardiovascular events. This study evaluated midterm outcomes of bmss vs cbe stents placed in the common iliac artery cia for aortoiliac occlusive disease. Guidelines for the management of patients with coronary. F shows cd 68 positive macrophages in the fibrous cap and in the underlying necrotic core. Data comparing these two stent technologies in ami with cs were limited. However, the high rates of target lesion revascularization associated with use of bms have led to the development of drugeluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late. Should we still have baremetal stentsavailable in our. Bare metal stents market size, share and global outlook by. Randomized trials and retrospective data suggest that covered balloonexpandable cbe stents have better shortterm patency compared with balloonexpandable baremetal stents bmss in the treatment of iliac artery disease. The following guidelines apply to using mri in all patients with coronary artery stents including two or more overlapped stents. Drugeluting or baremetal stents for acute myocardial infarction citations mauri l, silbaugh ts, garg p, wolf re, zelevinsky k, lovett a, varma mr, zhou z, normand sl, drugeluting or baremetal stents for acute myocardial infarction. Are drugeluting stents safer than baremetal stents. Methods a search strategy using the terms stents, drugeluting stents. This study compared clinical outcomes of drugeluting stents des versus bare metal stents bms in large coronary arteries in patients with acute myocardial.
We found no evidence of a difference when comparing drugeluting stents with baremetal stents on the relative risk rr of allcause mortality rr 0. Because dialysis usually qualifies ineligibility for randomized clinical. A bare metal stent, which is an expandable tube of metallic mesh, provides a physical scaffold for keeping a blood vessel patent. Pdf longterm outcomes with drugeluting stents versus. Coronary stent evolution with novel metal alloy composition, reduced strut thickness, enhanced platform flexibility and conformability, and improved polymer biocompatibility andor bioresorption has been associated with progressive, stepwise reductions in major adverse cardiovascular events mace, including stent thrombosis st, compared with baremetal stents. Effectiveness of drugeluting stents versus baremetal stents in. Stents that are covered with drugs that help keep the blood vessel from reclosing are called drugeluting stents. This chapter provides an understanding of physiology, history, and key features of cardiac catheters, bare metal stents, and grafts. Drugeluting or baremetal stents for coronary artery disease nejm. A pooled analysis of data comparing sirolimuseluting stents with baremetal stents.
A randomized comparison of drugeluting balloon versus everolimuseluting stent in patients with baremetal stentinstent restenosis. This study compared clinical outcomes of drugeluting stents des versus baremetal stents bms in large coronary arteries in patients with acute myocardial. Stents help prevent the artery from becoming blocked again restenosis. Backgroundlimited data are available on the longterm effects of contemporary drugeluting stents versus contemporary baremetal stents on. Indications, contraindications, warnings and instructions. Pvs is a serious condition with frequent restenosis after surgical and percutaneous interventions.
More recent 2nd generation stents use cobalt chromium alloy. Percutaneous coronary intervention with implantation of drugeluting stents des has reduced the need for repeat revascularisation compared with baremetal stents bms. Femoropopliteal drugeluting versus baremetal stents. At 6 years, the rates of the primary outcome were 16. The thrombus th was more apparent in the distal section taken 3 mm apart d. Drugeluting versus baremetal stents the medical roundtable. If the main drawback in deploying bare metal stents is that the opened vessel can reclose or undergo restenosis, maybe the driving force for restenosis can be altered by introducing a drug released from the polymer coating on the stent to enhance the proliferative capacity of cells adjacent to the stent or to.
Drugeluting coronaryartery stents university of southampton. This article requires a subscription or purchase to view the full text. Methods a costeffectiveness analysis was performed in the french national health insurance setting. The rebel stent system is the newest advance in baremetal stent technology. Indications, contraindications, warnings and instructions for use can be found in the labeling supplied with each product. Baremetal stents bms were introduced in the mid1990s with the aim of overcoming the deficiencies of balloon angioplasty. A comparison of covered vs bare expandable stents for the. Drugeluting or baremetal stents for coronary artery disease. It props open an artery and is left there permanently. Dual therapy stent dts bioresorbable vascular scaffold bvs bioengineered stent. Bare metal stents free download as powerpoint presentation. Platinum chromium baremetal stents acute clinical performance of bms is determined by a complex interplay of metal alloy and stent design. Drugeluting compared to bare metal stents in patients.
Baremetal stent is a stent without a coating or covering as used in covered stents drugeluting stents. A synthetic graft allows a weakened blood vessel wall to be replaced. The pathology of neoatherosclerosis in human coronary. An evaluation of the importance of bms in contemporary practice. Pdf to report clinical followup at 6 months after implantation of the ultrathin strut cobalt chromium solarflex stent in a realworld. Antonio colombo from san raffaele scientific institute and columbus hospital, milan, italy, dean kereiakes from the christ hospital heart and vascular center, cincinnati, oh, and ajay kirtane from columbia university medical centernew york. Request pdf drugeluting or baremetal stents for coronary artery disease background. Drugeluting stents compared with bare metal stents for stenting. Comparison of drug eluting versus bare metal stents for.