The third generation of drug-eluting stents: Reassuring data while we wait for the next one

The benefits of new technologies almost always come at a cost, often creating new problems, for which new solutions must be sought.The development of coronary stents is a perfect example of this.The first bare-metal stents (BMS) revolutionized percutaneous coronary intervention, since they overcame the acute and late elastic recoil seen after balloon angioplasty, thus significantly reducing the risk of restenosis, and solved the problem of acute vessel closure associated with balloon angioplasty due to vessel dissection. 1 However, despite these benefits, BMS were associated with neointimal hyperplasia due to deep arterial injury, resulting in in-stent restenosis in 15-30% of cases. 2 Stents eluting antiproliferative agents were the next step.The first generation of drug-eluting stents (DES) used sirolimus (Cypher, Cordis J&J) and paclitaxel (Taxus, Boston Scientific), incorporated in biostable polymers coating stainless steel stent platforms.These stents showed a significant reduction in in-stent restenosis, late lumen loss and rate of target lesion/vessel revascularization compared with BMS. 3 However, possibly due to delayed endothelialization secondary to antiproliferative drug elution and also hypersensitivity reactions to the polymer coating, these stents were later associated with an