Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory?
Key result
Bare-metal stents retain a necessary role in the cath lab despite superior newer-generation DES.
Why the study?
Despite improvements in newer-generation drug-eluting stents allowing shorter dual antiplatelet therapy, the ongoing clinical necessity of bare-metal stents in the cardiac catheterization laboratory remains an open question.
Key Points
- Assess whether bare-metal stents still have clinical indications or should be fully replaced by newer-generation drug-eluting stents in modern catheterization laboratories.
- Literature review evaluating historical and contemporary clinical trial evidence comparing bare-metal stents with drug-eluting stents across diverse patient subsets.
- Analysis of guideline recommendations, dual antiplatelet therapy duration requirements, and clinical outcomes including restenosis and stent thrombosis.
- Contemporary drug-eluting stents consistently reduce rates of in-stent restenosis and target lesion revascularization compared to bare-metal stents without increasing safety risks.
- Advances in polymer and stent technology have shortened the required duration of dual antiplatelet therapy for drug-eluting stents, effectively eliminating the primary historical indication for bare-metal stents.
PICO
P
Population
coronary artery disease
I
Intervention / Comparator
Bare-metal stents vs Drug-eluting stents
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“People now are under the assumption that bare-metal stents can be dispensed with. This is the view of many reputable, experienced people. This is a very opinionated view supported by no data.”
DKDavid KandzariInterventional cardiologist, Piedmont Hospital, Atlanta
“I cannot remember in years the last time I used a bare-metal stent, and further I'm not sure what brand of bare-metal stents we keep in inventory at our hospital if at all. And so it's not just me as an isolated practitioner but our whole program.”
Implication
Clinical review evaluates the utility of bare-metal stents in percutaneous coronary intervention, highlighting drug-eluting stents as the superior standard of care.
Abstract
The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration. Here, we aim to provide reasons as to why we still need BMS in our cardiac catheterization laboratory.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Colombo et al. (2017) conducted a review in coronary artery disease. Bare-metal stents vs. Drug-eluting stents was evaluated. Bare-metal stents may still be needed in the cardiac catheterization laboratory despite the superior safety and efficacy of newer-generation drug-eluting stents.