• Editorial: Is “Non-Inferiority” Good Enough? Approaching the Asymptote in DES

    In this issue of CRM, de la Torre Hernandez et al. present data from a propensity-matched, controlled study to examine the safety and efficacy of the ihtDEStiny BD stent and delivery system compared to established everolimus and zotarolimus, biodurable polymer DES [  ].

    The ihtDEStiny stent and its delivery system represent a novel approach that attempts to improve upon conventional second- and third-generation drug-eluting stents (DES). One of the potential improvements relates to the concept of a thinner strut. In this case, the struts of the ihtDEStiny stent are 74 μm compared to 91 and 93 μm for the comparator everolimus and zotarolimus stents, respectively. More on that later. In addition, the DEStiny stent, similar to the Synergy stent, only delivers the drug to the abluminal surface, without drug coating on the luminal side of the stent. This has the theoretical benefit of accelerating endothelial cell regrowth and early healing that could, theoretically, improve upon stent thrombosis and/or restenosis outcomes. Next, they use a polytetrafluoroethylene (PTFE) bioabsorbable coating on the abluminal surface of the stent to deliver sirolimus such that one might, theoretically, reduce the long-term “inflammatory” effects of a biodurable polymer. Finally, they use drug elution from the abluminal side of the balloon delivery system (drug-eluting balloon [DEB] delivery + stent) to further enhance the “uniformity” of drug delivery to the abluminal surface. In sum, the designers have created a novel product that theoretically should overcome some of the potential limitations, or perceived limitations, of existing DES, which should lead to better outcomes. But, as they say, “the best laid plans of mice and men …”

    Author bio

    Cardiovascular Revascularization Medicine, 2021-10-01, Volume 31, Pages 7-9


    Read the full article on Science Direct: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1553838921005029?returnurl=null&referrer=null

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