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Bare Metal Stents

Bare-metal coronary artery stents are used in percutaneous coronary intervention (PCI) for a variety of indications, including stable and unstable angina, acute myocardial infarction (MI), and multiple-vessel disease.

The benefit of DES in smaller vessels is attenuated in large diameter vessels (3.5 mm or greater) where restenosis is less of a problem and the number needed to treat to prevent one target vessel revascularization (TVR) is much larger, especially with shorter lesions.

Steinberg and colleagues examined outcomes at 30 days, 6 months, and 1 year in 233 patients with DES in vessels at least 3.5 mm diameter and compared them with 233 propensity-matched patients receiving BMS.1 There were no differences in TLR, TVR, or major adverse cardiovascular events, leading the authors to conclude that there was no benefit for DES in large diameter vessels.

Features

  The development of coronary stents greatly improved the outcomes and safety of percutaneous coronary intervention (PCI).

  The limitation of bare-metal stents (BMS) was restenosis and need for repeat target lesion revascularization (TLR), which was reduced with drug-eluting stents (DES). However, the delay in vessel healing associated with DES was associated with increased rates of late stent thrombosis and the requirement for longer duration dual antiplatelet therapy (DAPT).

  he benefit of DES in smaller vessels is attenuated in large diameter vessels (3.5 mm or greater) where restenosis is less of a problem and the number needed to treat to prevent one target vessel revascularization (TVR) is much larger, especially with shorter lesions.

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