Stent Thrombosis With Drug-Eluting Stents and Bioresorbable Scaffolds

Abstract

Contemporary DES, including biocompatible DP-DES, BP-DES, and polymer-free DES, showed a low risk of definite or probable stent thrombosis at 1 year. BVS had an increased risk of device thrombosis compared with CoCr-EES, PtCr-EES, and H-SES. Data from extended follow-up are warranted to confirm the long-term safety of contemporary coronary devices.

Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

“…[11][12][13][14][15][16] At 1-year follow-up, patients treated with Absorb BVS have shown non-inferior rates of TLF compared with the fluoropolymer everolimus-eluting stent (EES); however, a higher rate of target vessel myocardial infarction (TVMI) and ST was observed. 17,18 The promise of the bioresorbable scaffold is to decrease very late (>1 year) device-related events. Therefore, long-term data from randomized clinical trials are awaited and has started to emerge.…”

Overlapping meta-analyses of bioresorbable vascular scaffolds versus everolimus-eluting stents: bringing clarity or confusion?

“…Target-lesion and target-vessel revascularization did not differ between BVSs and EESs. Finally, a consistent finding across all metaanalyses was the approximately 2-fold increase in definite or probable device thrombosis with BVSs, which was significant in three out of five studies (11,12,14). Overlapping metaanalyses can result in a certain degree of ambiguity when they come to discordant conclusions (17).…”

“…Lipinski et al also combined study-level data but included only two randomized studies (ABSORB II and TROFI 2) and a number of non-randomized comparisons (11). Finally, Kang et al performed a network meta-analysis of 147 stent and scaffold trials, where the comparison of BVSs and EESs represents just one node of the framework, and the results reflect the combination of direct and indirect evidence estimates (14). When appraising if consistency exists in the results of overlapping meta-analyses of BVSs, a first major conundrum is that these results have not been uniformly reported for all the potential endpoints of interest.…”

“…Finally, the network meta-analysis approach chosen by Kang et al permitted to incorporate the direct evidence from the available trials of BVSs vs. EES and the indirect evidence from bare metal stents and DESs trials using common comparators. This enabled a consolidated ranking of contemporary coronary devices for the outcome of 1-year definite or probable thrombosis, with BVSs positioned at the lower end of the safety spectrum, at the same level of paclitaxel-eluting stents and bare metal stents (14).…”

Mechanical Causes of Stent Failure: OCT Insights

“…The process of drug eluting stent (DES) struts thinning that occurred in the last year with the introduction of cobalt-chromium devices has been of utmost importance to significantly reduce the incidence of stent thrombosis and restenosis [1,2]. Yet, suboptimal stent positioning represents a trigger for acute events even after deployment of scaffolds with optimal design and a valid polymerdrug combination [3][4][5][6][7].…”