Patient-tailored stent: Are we there yet?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Percutaneous coronary intervention (PCI) is a standard revascularization method.
• PCI outcomes depend on patient and procedure factors.
• Coronary stent technology has advanced from bare metal stents to multiple generations of drug-eluting stents (DES) and novel designs.

Purpose of the Study:

• To review the efficacy and safety of various coronary stents.
• To establish a strategy for patient-tailored stent selection in specific clinical and procedural scenarios.

Main Methods:

• Systematic review of current evidence on coronary stent performance.
• Analysis of stent characteristics including polymer type, drug elution, and strut thickness.
• Evaluation of outcomes in diverse patient populations and lesion complexities.

Main Results:

• Specific stent types show promise in various settings: sirolimus-eluting stents (SES) for small vessels, biodegradable-polymer SES for multivessel PCI, everolimus-eluting stents (EES) and zotarolimus-eluting stents for bifurcations, EES for chronic total occlusions.
• For diabetic patients, SES, EES, and polymer-free stents are suggested. Ultrathin biodegradable-polymer DES and titanium-nitride-oxide-coated stents are noted for acute coronary syndrome.
• Polymer-free biolimus-eluting stents may benefit high bleeding-risk patients.

Conclusions:

• Current evidence supports tailored stent selection for PCI success in specific scenarios.
• Further randomized trials are needed to solidify recommendations for optimal coronary stent use.