Clinical use of intracoronary bare metal stents
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- J Dawn Abbott, MD, FACC
J Dawn Abbott, MD, FACC
- Associate Professor of Medicine
- Brown Medical School
The development of bare metal stents (BMS) was a major advance relative to balloon angioplasty in the management of symptomatic coronary artery disease. BMS prevented restenosis by attenuating early arterial recoil and contraction. However, the rate of clinically indicated target lesion repeat revascularization due to restenosis at one year remained relatively high at 10 to 20 percent of patients and is often due to excessive growth of neointima [1-3]. (See "Intracoronary stent restenosis", section on 'Incidence of restenosis'.)
Drug-eluting stents (DES) were developed to reduce the high rate of restenosis and subsequent need for repeat revascularization with BMS. Clinical trials have confirmed a reduction of as much as 50 to 70 percent in target lesion revascularization by DES compared with BMS. These findings have led to the preferential use of DES in most stent cases. However, as DES likely require a longer period of dual antiplatelet therapy to prevent stent thrombosis, they may not be appropriate for all patients. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients", section on 'Summary and recommendations'.)
This topic will attempt to clarify the role of BMS in contemporary coronary artery disease interventional practice. The discussions of the various types of DES and coronary artery stent types in development are found elsewhere. (See "Comparison of drug-eluting intracoronary stents" and "Bioresorbable polymer or scaffold drug-eluting coronary artery stents".)
All coronary artery stents consist of a metallic backbone (table 1). Drug-eluting stents (DES) have an antiproliferative drug, and a polymer that serves as the vehicle for the drug and also controls the drug release rate. The drug inhibits excessive growth of neointima, a major cause of restenosis. Since each DES is unique, differences may be observed with respect to deliverability (ease of placement), efficacy (prevention of restenosis), and safety (rates of stent thrombosis). (See "Comparison of drug-eluting intracoronary stents".)
BMS COMPARED WITH DES
We prefer drug-eluting stents (DES) to bare metal stents (BMS) in most clinical situations. Current-generation DES have lower rates of clinically indicated repeat revascularization compared with BMS and are not limited by late safety concerns as were the first-generation DES.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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