• Editorial: The Big Issue of Small-Vessel Revascularization: The Ongoing Quest for a Solution

    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).

    Author bio

    Cardiovascular Revascularization Medicine Volume 25, April 2021, Pages 9-10

    Source:

    Read the full article on Science Direct: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1553838921000403?returnurl=null&referrer=null

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