Coronary stenting: Difference between revisions

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<ins>Improvements in antirestenotic drugs:</ins> Improvements in antirestenotic drugs have been relatively modest compared with the aforementioned improvements in stent platforms and polymers. Experiences with first-generation DES led the interventional cardiology community to conclude that sirolimus and its analogues were superior to paclitaxel for use on a DES. The cytotoxic properties of paclitaxel are probably too aggressive for the purpose of preventing formation of neointima, the more subtle anti-inflammatory and cytostatic effects of sirolimus seem to be better suited for this purpose. Several analogues of sirolimus have been developed, these are chemically altered forms of the drug with improved lipophilicity such as biolimus A9 or zotarolimus.  <br />
<ins>Improvements in antirestenotic drugs:</ins> Improvements in antirestenotic drugs have been relatively modest compared with the aforementioned improvements in stent platforms and polymers. Experiences with first-generation DES led the interventional cardiology community to conclude that sirolimus and its analogues were superior to paclitaxel for use on a DES. The cytotoxic properties of paclitaxel are probably too aggressive for the purpose of preventing formation of neointima, the more subtle anti-inflammatory and cytostatic effects of sirolimus seem to be better suited for this purpose. Several analogues of sirolimus have been developed, these are chemically altered forms of the drug with improved lipophilicity such as biolimus A9 or zotarolimus.  <br />


{| class="wikitable"
{| class="wikitable"
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| Durable
| Durable
|-
|-
! Row header A
! Taxus PES
| Cell B
| First-generation
| Cell C
| Paclitaxel
| 316L stainless steel (Express, Liberté), Platinum chromium (Element)
| Express: 132µm, Liberté: 97µm Element: 81µm
| 3-layer Styrene-isobutylene-Styrene copolymer
| 17.8µm
| Durable
|-
|-
! Row header A
! Resolute ZES
| Cell B
| Current-generation
| Cell C
| Zotarolimus
| L-605 cobalt chromium alloy
| 89µm
| 3-layer permanent biomimetic polymer; BioLinx (Endeavor Resolute)
| 5.6 µm
| Durable
|-
|-
! Row header A
! Xience V&trade;/Promus EES
| Cell B
| Current-generation
| Cell C
| Everolimus
| L-605 cobalt chromium alloy
| 81µm
| 2-layer permanent polymer
| 8µm
| Durable
|-
|-
! Row header A
! Promus Element EES
| Cell B
| Current-generation
| Cell C
| Everolimus
| Platinum-chromium alloy
| 81µm
| 2-layer permanent polymer
| 8µm
| Durable
|-
|-
! Row header A
! Biomatrix Flex/Nobori BES
| Cell B
| Current-generation
| Cell C
| Biolimus A9
| 316L stainless steel
| 112µm
| Abluminal side-only Bioaborbable polymer (fully absorbed within 6-9 months)
| 15µm 
| Bioresorbable
|-
|-
! Row header A
! BioFreedom BES
| Cell B
| Current-generation
| Cell C
| Biolimus A9
| 316L stainless stell
| 119 µm
| No polymer
| n/a
| No polymer, drug eluted from abluminal stent surface
|-
|-
! Row header A
! Synergy EES
| Cell B
| Current-generation
| Cell C
| Sirolimus
| Platinum-chromium alloy
| 74 µm
| PLGA (poly lactic-co-glycolic acid)
| 4 µm
| Bioresorbable, abluminal side onyl
|-
|-
! Row header A
! Orsiro SES
| Cell B
| Current-generation
| Cell C
| Everolimus
| L-605 cobalt chromium alloy
| 60 µm
| proBIO passive coating (amorphous silicon carbide) and BIOlute bioresorbable PLLA (poly-L-lactide) active coating
| 7.4 µm on abluminal surface, 3.5 µm on luminal surface
| Hybrid polymer, partly durable, partly bioresorbable
|}
|}