Bioabsorbable stents for adults with coronary artery disease : a review of the clinical effectiveness, cost-effectiveness, and guidelines

A drug-eluting stent (DES) is comprised of three components: a bare metal backbone (platform), the durable polymer, and anti-proliferative agents such as everolimus, biolimus, or sirolimus. The first-generation of DES, containing sirolimus or paclitaxel, was shown to reduce in-stent neointimal hyper...

Full description

Corporate Author: Canadian Agency for Drugs and Technologies in Health
Format: eBook
Language:English
Published: Ottawa (ON) Canadian Agency for Drugs and Technologies in Health 10 December 2013, 2013
Series:Rapid response report: summary with critical appraisal
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:A drug-eluting stent (DES) is comprised of three components: a bare metal backbone (platform), the durable polymer, and anti-proliferative agents such as everolimus, biolimus, or sirolimus. The first-generation of DES, containing sirolimus or paclitaxel, was shown to reduce in-stent neointimal hyperplasia, reduce rates of clinical restenosis, and curtail the need for repeated PCI compared with BMS. However, the greater risk of late stent thrombosis (LST) raised safety concerns. Hypersensitivity reactions to the durable polymer component of the first generation DES can produce chronic inflammation which is thought to delay endothelial healing and favour stent thrombosis (ST). ST was further stratified as early (d30 days), late (31 days to 1 year), or very late (beyond 1 year). The second-generation DES were thus developed using a thinner stent struts, permanent but biocompatible polymers to minimize inflammation or hypersensitivity reactions, and novel anti-proliferative agents.
One of the most common medical interventions performed in the treatment of coronary artery disease (CAD) today is the percutaneous coronary intervention (PCI), which opens clogged or damaged coronary arteries. Since its development in 1977, PCI has been a widely used alternative to coronary artery bypass grafting (CABG), and it relieves patients of coronary arterial blockage 90-95% of the time. PCI procedures include percutaneous transluminal coronary balloon angioplasty and coronary vascular stents (or scaffolds) such as bare metal stents (BMS), and drug eluting stents (DES). Coronary vascular stents are metallic scaffolds' that hold a blocked vessel open to restore coronary artery blood flow. The earliest type of stent developed was bare metal stent (BMS). Later, drug eluting stents (DES) were developed and widely used for PCI.
Bioabsorbable stents are expensive in comparison to durable polymer DES. The aim of this review is to evaluate the comparative clinical effectiveness, cost effectiveness comparing bioabsorbable stents with durable DES as well as to review the guidelines for DES use in patients with coronary artery disease (CAD)
The most recent innovation (the third generation) in stent technology is the development of bioabsorbable stents (also known as bioresorbable or biodegradable stents). Broadly speaking, bioabsorbable stents may include two main types: bioabsorbable polymer stents or stents with a bioabsorbable metallic backbone. With bioabsorbable polymer stent, a bioabsorbable polymer impregnated with anti-proliferative drug is designed to elute the drug from the metallic stent with the polymers gradually degraded after implantation. It was suggested that certain patients are currently deemed unsuitable for bioabsorbable stents in treating coronary artery disease. These include those with extensive calcified blockages and blockages at the side of branches that come off the main vessels. In some Canadian jurisdictions, it has been found that the use of bioabsorbable polymer stents is increasing with a decline of using durable (permanent or biocompatible) polymer DES.
Item Description:Title from PDF caption. - "CADTH rapid response service."
Physical Description:1 PDF file (27 pages)