<div class="inline-image figure ng-scope" id="f0005"> <figure> <div class="image-width-override j-image-for-image-view" ng-class="{'expanded': isInImageInterstitial}" dl="1-s2.0-S1553838921000403-fx1"> <div class="sized-image-container placeholder"><img src="https://d1niluoi1dd30v.cloudfront.net/15538389/S1553838921X00048/S1553838921000403/fx1.jpg?Signature=VW7eA6eUPOQHL-JSh04I%7ED2sASxH%7Eg4BL6IWk91npDEp66asSmZd9vy%7EdUq1dgRgH7l4FkZtahUK3QlZGhObGy-FirU0FIVcnzB33UjEtm6%7EmTXxWn4nVxjfvrmnTfu%7Emzs4GJjx6-tYzT2-knAk%7ELmMAgzj9bbWaePvdmQrOOM_&Expires=1629219663&Key-Pair-Id=APKAICLNFGBCWWYGVIZQ" /></div> </div> </figure> </div> <p class="ng-scope"></p> <p id="hl0000049" class="ng-scope">With about 20 randomized trials on the topic, management of patients presenting with coronary artery disease involving small vessels still represents a field of constant investigation – not seldom frustrating – and a setting of high complexity in our catheterization laboratories.</p> <p id="hl0000050" class="ng-scope">Indeed, across trials involving different invasive strategies – including plain old balloon angioplasty (POBA) and drug-eluting balloons (DEBs) – the incidence of target vessel failure remains high regardless of the type of treatment [<span> </span><button class="j-inline-reference inline-reference" data-refid="bb0005" id="refInSitubb0005">1</button><span> </span>]. Of note, trials with new-generation drug-eluting stents (DES) are still lacking. In the most recent meta-analysis by Siontis and colleagues [<span> </span><button class="j-inline-reference inline-reference" data-refid="bb0010" id="refInSitubb0010">2</button><span> </span>], the median target lesion revascularization (TLR) rate varied from 13% to 15% for DEB and DES, respectively, and there was an early incidence of myocardial infarction (MI) of up to 6.5%, with an average survival free of major adverse clinical events (MACEs) around 80%. With all the limitations described in their analysis, the authors reported a significantly better performance of the early generation sirolimus-eluting stents over the other strategies, including DEBs, paclitaxel-eluting stents, bare metal stents, and POBA. Furthermore, they suggested that further refinements in stent features – such as reduced strut thickness and polymer biocompatibility – may be associated with improved outcomes and lead to a finally optimal device for the treatment of this complex type of coronary artery disease (CAD).</p>