Patient-tailored stent: are we there yet?

Abstract

Percutaneous coronary intervention (PCI) has become a routine revascularization strategy. PCI outcome is affected by patient- and procedure-related factors. Stent design has evolved to overcome the risk of thrombosis and restenosis associated with stent implantation. Bare metal stents were followed by two generations of drug-eluting stents with different strut sizes, polymer types, and antiproliferative drug classes. Modern technologies comprising polymer-free stents, bioresorbable vascular scaffolds, and titanium-nitride-oxide-coated stents are intensively studied. The choice of the appropriate stent is crucial for PCI success, especially in high-risk settings. Hence, to establish a strategy for patient-tailored stent choice, we aimed to discuss the efficacy and safety of coronary stents in specific procedural and clinical scenarios. We concluded that the current evidence may encourage the use of (i) sirolimus-eluting stents (SES) in small vessel disease, (ii) biodegradable-polymer SES in multivessel PCI, (iii) everolimus-eluting stents (EES) and zotarolimus-eluting stents in bifurcation lesions, (iv) EES in chronic total occlusions, (v) SES, EES, and polymer-free stents in diabetic patients, (vi) ultrathin biodegradable-polymer DES and titanium-nitride-oxide-coated stents in acute coronary syndrome, and (vii) polymer-free biolimus-eluting stents in high bleeding-risk patients. Further randomized trials are required to established firm recommendations.