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.
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 [ ]. Of note, trials with new-generation drug-eluting stents (DES) are still lacking. In the most recent meta-analysis by Siontis and colleagues [ ], 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).
Cardiovascular Revascularization Medicine Volume 25, April 2021, Pages 9-10
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