Published in:
01-08-2015 | Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
Bare Metal Stents Versus Drug Eluting Stents: Where Do We Stand in 2015?
Authors:
Perwaiz M. Meraj, MD, FACC, FSCAI, Rajiv Jauhar, MD, FACC, Avneet Singh, MD, FACC
Published in:
Current Treatment Options in Cardiovascular Medicine
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Issue 8/2015
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Opinion statement
The development of bare metal stent (BMS) was a major advancement over plain old balloon angioplasty (POBA) in the management of symptomatic coronary artery disease. BMS prevented restenosis by attenuating early arterial recoil and contraction; both seen commonly after POBA. However, the rate of clinically indicated target lesion repeat revascularization due to a process of in-stent restenosis (ISR) at 1 year remained relatively high (10 to 20 %), often due to excessive neointimal growth (Fischman et al. N Engl J Med. 331:496,
1994; Serruys et al. N Engl J Med. 331:489,
1994; Cutlip et al. J Am Coll Cardiol 40:2082,
2002). Stents with drug elution technology (DES) were developed to reduce the relatively high rate of ISR and subsequent repeat revascularization seen with BMS. Clinical trials have confirmed a reduction of as much as 50 to 70 % in target lesion revascularization by DES compared to BMS. These findings have led to the preferential use of DES in the majority of percutaneous coronary intervention (PCI). However, as DES require a longer period of dual antiplatelet therapy (DAPT) to prevent stent thrombosis, DES are not appropriate for all patients.