Back To Search Results

Drug Eluting Stent Compounds

Editor: Judith Borger Updated: 7/4/2023 12:31:54 AM


Drug-eluting stents (DES) are vascular prostheses used by interventional cardiologists to reopen and maintain patent coronary arteries narrowed by arteriosclerosis. The history of interventional cardiology began with balloon angioplasty in 1977. Sigwart et al. introduced the first bare metal stent (BMS) in 1986.[1] In 2002 the first DES came to the markets in Europe. Today many companies are offering diverse DES to improve the treatment of coronary artery disease.[2][3] A multitude of studies providing evidence has paralleled this development. Real world practice emphasizes the clinical importance of stent technology illustrated by the fact that stent implantation occurs in 90% of PCI.

Facing the variety of DES, one can classify them according to three characteristics:

  1. Scaffold
  2. Drug-delivery mechanism (i.e., polymer)
  3. Therapeutic agent

The development of DES evolved through different generations. First-generation DES had a stainless steel scaffolding coated with either sirolimus or paclitaxel. The RAVEL, SIRIUS, and TAXUS trials evaluated first-generation DES.[4][5] Since studies showed the superiority of rapamycin agents, the second generation DES carried everolimus or zotarolimus. Second-generation DES has a cobalt-chromium scaffolding with different polymer coatings which allows decreased strut thickness, improved flexibility, deliverability, enhanced biocompatibility, better eluting profiles, and superior re-endothelialization. The ENDEAVOR and SPIRIT trials tested second-generation drug-eluting stents which are now the predominant implanted stents.[6][7][8] The third generation of DES with a biodegradable polymer or entirely bioabsorbable scaffolds are just undergoing clinical testing.[9]

Stents prevent the vascular recoil cardiologists observed with balloon angioplasty (PTCA). Bare metal stents (BMS) are superior to PTCA alone as was shown in the BENESTENT and STRESS trials.[10] But following BMS implantation, restenosis develops in 30% of cases. Early restenosis results from neointimal hyperplasia because of migration and proliferation of vascular smooth muscle cells as a response to vascular injury from the stent deployment.[11][12][13] To reduce restenosis rate, DES evolved from BMS. Both share the common scaffold structure. But in drug-eluting stents, an antiproliferative drug coats the scaffold to reduce cell proliferation inside the stent and also treat the complication of early restenosis.[14] This development led to a significant reduction of early restenosis. Long-term trials, however, revealed another problem, which is late (>30 days) and very late (>12 months) stent thrombosis.[15][16][17] Adequately powered long-term trials have shown that drug-eluting stents correlate with this complication. The reason for stent thrombosis is the antiproliferative effect of DES, which slows re-endothelialization of the prosthetic material. After cessation of oral antiplatelet therapy, the uncovered scaffold material can trigger platelet activation, and late restenosis or thrombosis occurs.[18][19] Whereas restenosis due to neointimal hyperplasia is a slow process, stent thrombosis occurs suddenly with acute life-threatening symptoms. It has a low incidence but high mortality.[20] Thus, anticoagulation is crucial after implantation of stents.[21] 

Problems with hypersensitivity to stents have been proposed and subsequently, the concept of polymer-free or biodegradable polymers was introduced. Recently reestablishment of healthy long-term vasomotion with biodegradable stents have gained significance. 

Different characteristics make each drug-eluting stent unique. Each of them has advantages and disadvantages which derive from differences in drug-loading capacity, drug-release pharmacokinetics, polymer durability, biocompatibility, influence on vascular wall thinning, aneurysm formation, and delayed restenosis.[22] Different complications can occur following the implantation of stents. Materials not native to the human body involve questions of biocompatibility. Problems of corrosion and release of toxic substances led to the investigation of more biocompatible and degradable compounds. Early biocompatibility problems include stent thrombosis, inflammation, and neointima formation. A late problem associated with decreased biocompatibility is scaffold fracture due to material fatigue.

The FDA MAUDE database showed that most stent fractures do not trigger symptoms, are difficult to assess and thus, are probably under-recognized.[23] Risk factors for stent fracture are stent length (5cm vs. 3cm) and stents placed in bypass grafts or the RCA location.[24][25][26] The FDA requires manufacturers to demonstrate 10-year life duration for stents through stress testing.[27][26] Stent fracture without restenosis treated only conservatively shows good outcomes.[25] Malapposition is the problem of incomplete alignment of the stent struts to the vessel surface. It occurs in 2 to 5% of the cases and is a cause of late stent thrombosis.[28][29]

Issues of Concern

Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
  • Dropdown arrow Search engine and full access to all medical articles
  • Dropdown arrow 10 free questions in your specialty
  • Dropdown arrow Free CME/CE Activities
  • Dropdown arrow Free daily question in your email
  • Dropdown arrow Save favorite articles to your dashboard
  • Dropdown arrow Emails offering discounts

Learn more about a Subscription to StatPearls Point-of-Care

Issues of Concern

The Scaffold

Stents can be classified according to characteristics like metallic basis and design.[30] Different metallic compounds can serve as stent scaffold which gets further characterized by unique physical properties such as radial strength, ferromagneticity, material fatigue, and radiolucency.[31] Radial strength measures the resistance to external compression. Radiolucency characterizes the visibility of the stent during angiography.

Stainless steel or tantalum was used in early BMS.[31] Tantalum has a good visibility during angiography and lack of ferromagnetism. Following implantation, tantalum undergoes oxidation that makes it stable and resistant to degradation which results in better biocompatibility.[32][33] Tantalum showed similar thrombogenicity but better radio-opacity compared to stainless steel and is appreciated for its mechanical strength.[34][32] By comparison, 316L stainless steel with low carbon content is a mixture of iron, chromium, and nickel.

Later on, nitinol, a combination of nickel and titanium, was introduced into clinical practice as it exhibited elastic properties and thermal shape memory.[35] The thermal memory allows for the expansion of the nitinol stent once inside the body and smooth adaption to surrounding geometry.

Recent stent backbones are made from chromium combinations with either cobalt or platinum as they allow thin strut structure. Cobalt chromium stents are a choice in higher-risk lesions due to their high radial strength, low profile and increased elasticity.[36][37] Cobalt chromium scaffolds (MP35N, L605) compared with stainless steel scaffolds showed a lower risk for target vessel revascularization.[38][39][40] The platinum chromium stent possesses characteristics of good flexibility, deliverability, conformability, radial strength, and visibility.[41]

Due to improved scaffold materials having higher radial strength, strut thickness decreased from around 140 micrometers in thick-strut stents to around 70 micrometers in thin-strut stents. The ISAR-STEREO trial showed the superiority of thin-strut stents with lower restenosis.[42][43]

The problem of metal allergy plays no role in the pathogenesis of restenosis, but its influence on outcome shows contradictory evidence.[44][45][46] Some authors propose patch testing prior to implantation. [45] Nickel is especially known for its allergic potential and has been banned from textiles in many countries. Stainless steel, cobalt, chromium, and platinum chromium are the most commonly used alloys.[27]

Apart from the metallic basis, scaffold design has clinical implications as relates to vessel injury during implantation, and different designs result in different injury patterns with greater injury leading to increased tissue proliferation and platelet adhesion. [47] Stent designs include delta wing stent,[48] coil stent, tubular mesh stent, tubular slotted stent, and corrugated ring stent. The corrugated ring stent design showed less tissue proliferation than the tubular slotted stent design.[49]

Multicellular stents can subdivide into closed-cell and open-cell designs. Closed-cell stents show a more uniform drug delivery but are less flexible, whereas open-cell stents have a non-uniform drug distribution but improved alignment to the vessel.[50][51] In the PAST study, closed-cell stents triggered less platelet adhesion.[47] Uniform endothelial coverage can be achieved with flexible stent design and reduces stent thrombosis.[52]

Bioabsorbable stents are non-permanent implants avoiding caging vessels and obstructing side branches and allow vasomotion.[48] They are made either from metallic or polymeric scaffolds. The basis of metallic biodegradable scaffolds is magnesium or iron. The pharmacological properties of these two compounds are well known.[53] A growing number of synthetic or natural polymers are available to create biodegradable scaffolds such as poly-(L-lactic acid) (PLLA) or amino acids such as tyrosine.[54][53] 

The Therapeutic Agent

Antiproliferative drugs stop vascular smooth muscle cell proliferation and thus, neointimal hyperplasia. Sirolimus and paclitaxel were used in first generation DES. Paclitaxel inhibits microtubule disassembly and thus interferes with the cell cycle, leading to cell cycle arrest in G0-G1 and G2-M phases.[55] Sirolimus binds to the FKBP12 and subsequently inhibits mTOR and PI3 pathway, arresting the cell cycle in the G1 phase.[56][57] In clinical studies (i.e., REALITY, SIRTAX, ISAR-DESIRE) sirolimus-eluting stents (SES) outperformed paclitaxel-eluting stents (PES) regarding restenosis rate.[58] Although both inhibit the cell cycle differences in dosage, release kinetics, immunosuppressive properties, and distribution among the vessel wall layers might contribute to the clinical inferiority of paclitaxel-eluting stents.[59][60] Additionally, shear stress has been shown to vary between these two stent types.[61]

Therefore, later generation stent therapeutic agents evolved from sirolimus. Changes to the sirolimus structure created compounds such as everolimus (SDZ RAD) which showed anti-arteriosclerotic features and prevented graft rejection.[62][63] Ridaforolimus was non-inferior to zotarolimus in the BIONICS trial.[64] Further rapamycin agents include biolimus and novolimus. Concerns about tissue factor increase as a side effect of rapamycin agents have related to stent thrombosis.[65]

Other investigated therapeutic agents are[66][67][68][69][70][71][72][73][74]

  • Dual drug-eluting stents DDES, which carry two therapeutic agents to combine their mechanism of action, for example antiproliferative and additional anti-thrombotic effects. The modification of the coating allows time controlled release of the drugs targeting the different timing of bio-response to stent implantation.
  • Phytoncide (PTC), which shows the same anti-inflammatory and antiproliferative effects in vitro as sirolimus and thus might serve as an alternative to sirolimus
  • Glucocorticoids, which are useful to suppress inflammatory changes that lead to restenosis
  • Gene eluting stents, which deliver plasmid DNA to express appreciated proteins inside cells. The expression of VEGF, for example, supports healthy endothelialization of the stent luminal surface
  • Galangin, which up-regulates p27KIP1 that arrests cell cycle in the G0-G1 phase, inhibits proliferation of vascular smooth muscle cells
  • Tacrolimus reduces restenosis via the calcineurin/NFAT/IL-2 pathway but is inferior in head-to-head comparison to other stents eluting rapamycin agents
  • Stem-cell carrying stents to support healthy reendothelialization
  • Radioactive stents
  • Actinomycin
  • Probucol
  • 7-Hexanoyltaxol

The Coating

Stent coating serves different purposes. It facilitates drug stent adhesion, drug-release, biocompatibility, and modulates thrombogenicity. Polymers are repeating sequences of chemical connections. Drug delivery via polymers follows the principle of diffusion, dissolution or ion exchange.[75] The group of coating materials further subdivide as[31]:

  • Organic or inorganic
  • Bio-erodable or permanent
  • Uniform or nonuniform drug delivery
  • Luminal or abluminal coating
  • Active or passive

First generation DES used synthetic polymers such as poly(ethylene-co-vinyl acetate) (PEVA) and poly(n-butyl methacrylate) (PBMA) or tri-block copolymer poly(styrene-b-isobtylene-b-styrene) (SIBS). PEVA and PBMA coat SES whereas SIBS coats PES. SIBS allows early burst release of the drug which is ideal for controlling the early vascular injury following stent implantation. Observations of late stent thrombosis with PEVA and PBMA triggered investigations to find the underlying causes. Hypersensitivity arose as a factor as tissue surrounding stents became infiltrated by inflammatory cells.[76] To reduce inflammation following stenting, more biocompatible polymers such as phosphorylcholine (PC) and copolymer poly(vinylidene flouride-co-hexaflouropropylene) (PVDF-HFP) coat second-generation drug-eluting stents. Phosphorylcholine (PC) is a natural constituent of the phospholipid bilayer cell membrane. Since PC reduces platelet adhesion, it is useful to reduce thrombosis. Large vessel grafts are made from poly(bis(trifluoroethoxyl)phosphazene (PTFE).

Other coating options include[77][78]:

  • Gold-coated stents, which exhibited an increased risk for restenosis
  • Heparin
  • Endothelial cells or its progenitors
  • CD34 antibodies
  • Natural glycocalyx

To further reduce the inflammatory response, stent coatings employed bioabsorbable polymers such as poly-lactic acid (PLA), poly(lactide-co-glycolide) (PLGA) and polycaprolactone (PCL).[79][80]  Experience with PLA derives from the application in clinical practice as sutures or screws and grafts and meshes.[81][82] A study comparing PLGA and PCL associated their different degradation to acidification of the surrounding tissue and cell proliferation and migration.[83] Poly(lactic acid-co-glycolic acid) (PLGA) degrades by hydrolysis in 6 months. It exhibits low immunogenicity, good biocompatibility, and mechanical characteristics.[84] Different trials (LEADERS, COMPARE II, NEXT, and CENTURY II) showed promising results for biodegradable polymer thin-strut drug-eluting stents compared with thin-strut permanent polymer drug-eluting stents.[85][86] 

The problems associated with coating polymers such as inflammation or hypersensitivity can be avoided altogether by using drug reservoirs stents or nanoparticles.

Clinical Significance

The plentitude of different drug-eluting stents requires knowledge about their characteristics to align the advantages and disadvantages of the stent with the requirement of each unique lesion. Stent performance depends strongly on lesion characteristics.[87] Arterial response to stent implantation is complex, and thus preclinical (i.e., animal) studies are key to predict performance in humans.[88] There is not one ideal stent, but different stents are better suited for different situations. For example, small diameter stents have been designed for narrow vessel treatment (<2.5 to 3.0mm).[89][90] Since real-world experience showed frequent off-label usage, there has been a broadening of the indications for DES placement.[91] 

New-generation DES can be used in complex lesions such as with diabetic patients,[92] chronic kidney disease,[93] acute myocardial infarction (as was investigated in the HORIZONS-AMI trial),[94] ostial lesions or bifurcations,[95] bypass grafts, as an alternative to coronary artery bypass grafting in left main stem disease,[96] small vessels or long lesions, restenosis, and chronic occlusions.

Bare metal stents are not outdated, but drug-eluting stents have largely replaced them.[39] Some authors argue that practice adaption and application of DES has been too fast.[14] BMS are still used in about 20% of PCI and indicated in patients that have limited DAPT options (awaiting surgery, compliance issues, bleeding risk, preexisting atrial fibrillation). BMS may also be preferable in large vessel lesions, acute myocardial infarction, and regarding costs.[97] In the US, a BMS costs round about 1,000 USD and a DES around 3,000 USD. Comparing costs requires considering long-term outcomes that favor DES because of less reintervention and thus improved cost-benefit-analysis.[98][99][100]

The discussion about the appropriateness of real-world stenting practice is ongoing. For example, the NORSTENT study emphasized the advantages of BMS compared to DES. Designing studies and finding evidence is difficult, which can be illustrated by the fact that the progression of restenosis differs, which makes early angiographic measures unrelated to late stenotic changes. Measuring restenosis risk as a surrogate is common among studies, but it may not correlate with clinical endpoints such as death and myocardial infarction.[101] 

Evidence advocates for everolimus-eluting stents, which exhibit the most favorable outcomes and the future might belong to biodegradable polymers and bioabsorbable scaffolds.[102][103] Until now evidence did not show the superiority of bioresorbable scaffold stents over second-generation drug-eluting stents.[48] Lee and Torre Hernandez describe in their article the ideal stent of the future as showing good deliverability, having thin struts, being highly visible, carrying a rapamycin agent that is eluted for two to three months and being coated by a thin layer polymer allowing for short duration DAPT.[104]



Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. The New England journal of medicine. 1987 Mar 19:316(12):701-6     [PubMed PMID: 2950322]

Level 3 (low-level) evidence


Htay T, Liu MW. Drug-eluting stent: a review and update. Vascular health and risk management. 2005:1(4):263-76     [PubMed PMID: 17315599]


Martin DM, Boyle FJ. Drug-eluting stents for coronary artery disease: a review. Medical engineering & physics. 2011 Mar:33(2):148-63. doi: 10.1016/j.medengphy.2010.10.009. Epub     [PubMed PMID: 21075668]


Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME, TAXUS-IV Investigators. One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV trial. Circulation. 2004 Apr 27:109(16):1942-7     [PubMed PMID: 15078803]

Level 1 (high-level) evidence


Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME, TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. The New England journal of medicine. 2004 Jan 15:350(3):221-31     [PubMed PMID: 14724301]

Level 1 (high-level) evidence


Kandzari DE, Leon MB, Meredith I, Fajadet J, Wijns W, Mauri L. Final 5-year outcomes from the Endeavor zotarolimus-eluting stent clinical trial program: comparison of safety and efficacy with first-generation drug-eluting and bare-metal stents. JACC. Cardiovascular interventions. 2013 May:6(5):504-12. doi: 10.1016/j.jcin.2012.12.125. Epub 2013 Apr 17     [PubMed PMID: 23602459]


Leon MB, Mauri L, Popma JJ, Cutlip DE, Nikolsky E, O'Shaughnessy C, Overlie PA, McLaurin BT, Solomon SL, Douglas JS Jr, Ball MW, Caputo RP, Jain A, Tolleson TR, Reen BM 3rd, Kirtane AJ, Fitzgerald PJ, Thompson K, Kandzari DE, ENDEAVOR IV Investigators. A randomized comparison of the Endeavor zotarolimus-eluting stent versus the TAXUS paclitaxel-eluting stent in de novo native coronary lesions 12-month outcomes from the ENDEAVOR IV trial. Journal of the American College of Cardiology. 2010 Feb 9:55(6):543-54. doi: 10.1016/j.jacc.2009.08.067. Epub     [PubMed PMID: 20152559]

Level 1 (high-level) evidence


Mauri L, Massaro JM, Jiang S, Meredith I, Wijns W, Fajadet J, Kandzari DE, Leon MB, Cutlip DE, Thompson KP. Long-term clinical outcomes with zotarolimus-eluting versus bare-metal coronary stents. JACC. Cardiovascular interventions. 2010 Dec:3(12):1240-9. doi: 10.1016/j.jcin.2010.08.021. Epub     [PubMed PMID: 21232717]

Level 2 (mid-level) evidence


Simard T, Hibbert B, Ramirez FD, Froeschl M, Chen YX, O'Brien ER. The evolution of coronary stents: a brief review. The Canadian journal of cardiology. 2014 Jan:30(1):35-45. doi: 10.1016/j.cjca.2013.09.012. Epub 2013 Nov 25     [PubMed PMID: 24286961]


Eberhart RC, Su SH, Nguyen KT, Zilberman M, Tang L, Nelson KD, Frenkel P. Bioresorbable polymeric stents: current status and future promise. Journal of biomaterials science. Polymer edition. 2003:14(4):299-312     [PubMed PMID: 12747671]


Schwartz RS, Huber KC, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, Holmes DR. Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. Journal of the American College of Cardiology. 1992 Feb:19(2):267-74     [PubMed PMID: 1732351]

Level 3 (low-level) evidence


Hoffmann R, Mintz GS, Dussaillant GR, Popma JJ, Pichard AD, Satler LF, Kent KM, Griffin J, Leon MB. Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation. 1996 Sep 15:94(6):1247-54     [PubMed PMID: 8822976]


Ross R, Glomset J, Harker L. Response to injury and atherogenesis. The American journal of pathology. 1977 Mar:86(3):675-84     [PubMed PMID: 842616]


Tung R, Kaul S, Diamond GA, Shah PK. Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence. Annals of internal medicine. 2006 Jun 20:144(12):913-9     [PubMed PMID: 16785479]

Level 3 (low-level) evidence


Lüscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, Virmani R. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007 Feb 27:115(8):1051-8     [PubMed PMID: 17325255]


Abbott JD. Revealing the silver and red lining in drug-eluting stents with angioscopy. Circulation. Cardiovascular interventions. 2008 Aug:1(1):7-9. doi: 10.1161/CIRCINTERVENTIONS.108.802926. Epub     [PubMed PMID: 20031649]


Finn AV, Nakazawa G, Joner M, Kolodgie FD, Mont EK, Gold HK, Virmani R. Vascular responses to drug eluting stents: importance of delayed healing. Arteriosclerosis, thrombosis, and vascular biology. 2007 Jul:27(7):1500-10     [PubMed PMID: 17510464]

Level 3 (low-level) evidence


Lee CW, Park DW, Lee BK, Kim YH, Hong MK, Kim JJ, Park SW, Park SJ. Predictors of restenosis after placement of drug-eluting stents in one or more coronary arteries. The American journal of cardiology. 2006 Feb 15:97(4):506-11     [PubMed PMID: 16461047]


Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005 May 4:293(17):2126-30     [PubMed PMID: 15870416]


Montalescot G, Hulot JS, Collet JP. Stent thrombosis: who's guilty? European heart journal. 2009 Nov:30(22):2685-8. doi: 10.1093/eurheartj/ehp436. Epub 2009 Oct 23     [PubMed PMID: 19854727]


Sourgounis A, Lipiecki J, Lo TS, Hamon M. Coronary stents and chronic anticoagulation. Circulation. 2009 Mar 31:119(12):1682-8. doi: 10.1161/CIRCULATIONAHA.108.834861. Epub     [PubMed PMID: 19332481]

Level 3 (low-level) evidence


Otsuka Y, Saito S, Nakamura M, Shuto H, Mitsudo K. Comparison of pharmacokinetics of the limus-eluting stents in Japanese patients. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2011 Dec 1:78(7):1078-85. doi: 10.1002/ccd.23096. Epub 2011 Nov 2     [PubMed PMID: 21538783]

Level 2 (mid-level) evidence


Chhatriwalla AK, Cam A, Unzek S, Bhatt DL, Raymond RE, Lincoff AM, Whitlow PL, Ellis SG, Tuzcu EM, Kapadia SR. Drug-eluting stent fracture and acute coronary syndrome. Cardiovascular revascularization medicine : including molecular interventions. 2009 Jul-Sep:10(3):166-71. doi: 10.1016/j.carrev.2009.02.003. Epub     [PubMed PMID: 19595398]


Aoki J, Nakazawa G, Tanabe K, Hoye A, Yamamoto H, Nakayama T, Onuma Y, Higashikuni Y, Otsuki S, Yagishita A, Yachi S, Nakajima H, Hara K. Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2007 Feb 15:69(3):380-6     [PubMed PMID: 17195199]


Park KW, Park JJ, Chae IH, Seo JB, Yang HM, Lee HY, Kang HJ, Cho YS, Yeon TJ, Chung WY, Koo BK, Choi DJ, Oh BH, Park YB, Kim HS. Clinical characteristics of coronary drug-eluting stent fracture: insights from a two-center des registry. Journal of Korean medical science. 2011 Jan:26(1):53-8. doi: 10.3346/jkms.2011.26.1.53. Epub 2010 Dec 22     [PubMed PMID: 21218030]

Level 2 (mid-level) evidence


Everett KD, Conway C, Desany GJ, Baker BL, Choi G, Taylor CA, Edelman ER. Structural Mechanics Predictions Relating to Clinical Coronary Stent Fracture in a 5 Year Period in FDA MAUDE Database. Annals of biomedical engineering. 2016 Feb:44(2):391-403. doi: 10.1007/s10439-015-1476-3. Epub 2015 Oct 14     [PubMed PMID: 26467552]


Conway C. Coronary Stent Fracture: Clinical Evidence Vs. the Testing Paradigm. Cardiovascular engineering and technology. 2018 Dec:9(4):752-760. doi: 10.1007/s13239-018-00384-0. Epub 2018 Oct 19     [PubMed PMID: 30341730]


Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, Vogel R, Hess O, Meier B, Windecker S. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation. 2007 May 8:115(18):2426-34     [PubMed PMID: 17485593]


Hong MK, Mintz GS, Lee CW, Park DW, Park KM, Lee BK, Kim YH, Song JM, Han KH, Kang DH, Cheong SS, Song JK, Kim JJ, Park SW, Park SJ. Late stent malapposition after drug-eluting stent implantation: an intravascular ultrasound analysis with long-term follow-up. Circulation. 2006 Jan 24:113(3):414-9     [PubMed PMID: 16432073]

Level 2 (mid-level) evidence


Butany J, Carmichael K, Leong SW, Collins MJ. Coronary artery stents: identification and evaluation. Journal of clinical pathology. 2005 Aug:58(8):795-804     [PubMed PMID: 16049279]


Bertrand OF, Sipehia R, Mongrain R, Rodés J, Tardif JC, Bilodeau L, Côté G, Bourassa MG. Biocompatibility aspects of new stent technology. Journal of the American College of Cardiology. 1998 Sep:32(3):562-71     [PubMed PMID: 9741494]

Level 3 (low-level) evidence


Abizaid A, Popma JJ, Tanajura LF, Hattori K, Solberg B, Larracas C, Feres F, Costa Jde R Jr, Schwartz LB. Clinical and angiographic results of percutaneous coronary revascularization using a trilayer stainless steel-tantalum-stainless steel phosphorylcholine-coated stent: the TriMaxx trial. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2007 Dec 1:70(7):914-9     [PubMed PMID: 18044791]


Hamm CW, Beythien C, Sievert H, Langer A, Utech A, Terres W, Reifart N. Multicenter evaluation of the Strecker tantalum stent for acute coronary occlusion after angioplasty. American heart journal. 1995 Mar:129(3):423-9     [PubMed PMID: 7872165]


Scott NA, Robinson KA, Nunes GL, Thomas CN, Viel K, King SB 3rd, Harker LA, Rowland SM, Juman I, Cipolla GD. Comparison of the thrombogenicity of stainless steel and tantalum coronary stents. American heart journal. 1995 May:129(5):866-72     [PubMed PMID: 7732974]

Level 3 (low-level) evidence


Stoeckel D, Pelton A, Duerig T. Self-expanding nitinol stents: material and design considerations. European radiology. 2004 Feb:14(2):292-301     [PubMed PMID: 12955452]


Milewski K, Zurakowski A, Pajak J, Pajak-Zielinska E, Liszka L, Buszman PP, Bis J, Debinski M, Buszman PE. Comparison of thin-strut cobalt-chromium stents and stainless steel stents in a porcine model of neointimal hyperplasia. Medical science monitor : international medical journal of experimental and clinical research. 2010 Jan:16(1):BR40-4     [PubMed PMID: 20037484]

Level 3 (low-level) evidence


Menown IB, Noad R, Garcia EJ, Meredith I. The platinum chromium element stent platform: from alloy, to design, to clinical practice. Advances in therapy. 2010 Mar:27(3):129-41. doi: 10.1007/s12325-010-0022-9. Epub 2010 Apr 29     [PubMed PMID: 20437213]

Level 3 (low-level) evidence


Koh AS, Choi LM, Sim LL, Tan JW, Khin LW, Chua TS, Koh TH, Chia S. Comparing the use of cobalt chromium stents to stainless steel stents in primary percutaneous coronary intervention for acute myocardial infarction: a prospective registry. Acute cardiac care. 2011 Dec:13(4):219-22. doi: 10.3109/17482941.2011.634011. Epub     [PubMed PMID: 22142201]


Abreu Filho LM, Forte AA, Sumita MK, Favarato D, Meireles GC. Influence of metal alloy and the profile of coronary stents in patients with multivessel coronary disease. Clinics (Sao Paulo, Brazil). 2011:66(6):985-9     [PubMed PMID: 21808863]

Level 1 (high-level) evidence


Youssef AA, Hussein H, Hsueh SK, Chen CJ, Yang CH, Hang CL, Hsieh YK, Fang CY, Yip HK, Wu CJ. Cobalt chromium coronary stents and drug-eluting stents in real practice. International heart journal. 2010 Jul:51(4):231-7     [PubMed PMID: 20716838]

Level 2 (mid-level) evidence


Jorge C, Dubois C. Clinical utility of platinum chromium bare-metal stents in coronary heart disease. Medical devices (Auckland, N.Z.). 2015:8():359-67. doi: 10.2147/MDER.S69415. Epub 2015 Aug 27     [PubMed PMID: 26345228]


Zahedmanesh H, Lally C. Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis. Medical & biological engineering & computing. 2009 Apr:47(4):385-93. doi: 10.1007/s11517-009-0432-5. Epub 2009 Feb 3     [PubMed PMID: 19189146]


Kastrati A, Mehilli J, Dirschinger J, Dotzer F, Schühlen H, Neumann FJ, Fleckenstein M, Pfafferott C, Seyfarth M, Schömig A. Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation. 2001 Jun 12:103(23):2816-21     [PubMed PMID: 11401938]

Level 1 (high-level) evidence


Slodownik D, Danenberg C, Merkin D, Swaid F, Moshe S, Ingber A, Lotan H, Durst R. Coronary stent restenosis and the association with allergy to metal content of 316L stainless steel. Cardiovascular journal of Africa. 2018 Jan/Feb 23:29(1):43-45. doi: 10.5830/CVJA-2017-036. Epub 2018 Jan 24     [PubMed PMID: 29443350]


Gong Z,Li M,Guo X,Ma Z,Shi J, Stent implantation in patients with metal allergy: a systemic review and meta-analysis. Coronary artery disease. 2013 Dec     [PubMed PMID: 24135817]

Level 1 (high-level) evidence


Romero-Brufau S, Best PJ, Holmes DR Jr, Mathew V, Davis MD, Sandhu GS, Lennon RJ, Rihal CS, Gulati R. Outcomes after coronary stent implantation in patients with metal allergy. Circulation. Cardiovascular interventions. 2012 Apr:5(2):220-6. doi: 10.1161/CIRCINTERVENTIONS.111.966614. Epub 2012 Mar 27     [PubMed PMID: 22456027]

Level 2 (mid-level) evidence


Gurbel PA, Callahan KP, Malinin AI, Serebruany VL, Gillis J. Could stent design affect platelet activation? Results of the Platelet Activation in STenting (PAST) Study. The Journal of invasive cardiology. 2002 Oct:14(10):584-9     [PubMed PMID: 12368510]

Level 3 (low-level) evidence


Dziewierz A, Dudek D. Current perspectives on the role of bioresorbable scaffolds in the management of coronary artery disease. Kardiologia polska. 2018:76(7):1043-1054. doi: 10.5603/KP.a2018.0130. Epub     [PubMed PMID: 30251247]

Level 3 (low-level) evidence


Hoffmann R,Jansen C,König A,Haager PK,Kerckhoff G,vom Dahl J,Klauss V,Hanrath P,Mudra H, Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study. European heart journal. 2001 Nov;     [PubMed PMID: 11603908]


Welt FG, Rogers C. Inflammation and restenosis in the stent era. Arteriosclerosis, thrombosis, and vascular biology. 2002 Nov 1:22(11):1769-76     [PubMed PMID: 12426203]

Level 3 (low-level) evidence


Haase J, Störger H, Hofmann M, Schwarz CE, Reinemer H, Schwarz F. Comparison of stainless steel stents coated with turbostratic carbon and uncoated stents for percutaneous coronary interventions. The Journal of invasive cardiology. 2003 Oct:15(10):562-5     [PubMed PMID: 14519887]

Level 1 (high-level) evidence


Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation. 2007 May 8:115(18):2435-41     [PubMed PMID: 17438147]


Moravej M,Mantovani D, Biodegradable metals for cardiovascular stent application: interests and new opportunities. International journal of molecular sciences. 2011     [PubMed PMID: 21845076]


Gundogan B, Tan A, Farhatnia Y, Alavijeh MS, Cui Z, Seifalian AM. Bioabsorbable stent quo vadis: a case for nano-theranostics. Theranostics. 2014:4(5):514-33. doi: 10.7150/thno.8137. Epub 2014 Feb 22     [PubMed PMID: 24672583]

Level 3 (low-level) evidence


Stone GW, Ellis SG, Cannon L, Mann JT, Greenberg JD, Spriggs D, O'Shaughnessy CD, DeMaio S, Hall P, Popma JJ, Koglin J, Russell ME, TAXUS V Investigators. Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA. 2005 Sep 14:294(10):1215-23     [PubMed PMID: 16160130]

Level 1 (high-level) evidence


Chatterjee S, Pandey A. Drug eluting stents: friend or foe? A review of cellular mechanisms behind the effects of Paclitaxel and sirolimus eluting stents. Current drug metabolism. 2008 Jul:9(6):554-66     [PubMed PMID: 18680476]

Level 3 (low-level) evidence


Marks AR, Sirolimus for the prevention of in-stent restenosis in a coronary artery. The New England journal of medicine. 2003 Oct 2;     [PubMed PMID: 14523135]


Abizaid A. Sirolimus-eluting coronary stents: a review. Vascular health and risk management. 2007:3(2):191-201     [PubMed PMID: 17580729]


Levin AD, Jonas M, Hwang CW, Edelman ER. Local and systemic drug competition in drug-eluting stent tissue deposition properties. Journal of controlled release : official journal of the Controlled Release Society. 2005 Dec 5:109(1-3):236-43     [PubMed PMID: 16289420]

Level 3 (low-level) evidence


Wessely R, Schömig A, Kastrati A. Sirolimus and Paclitaxel on polymer-based drug-eluting stents: similar but different. Journal of the American College of Cardiology. 2006 Feb 21:47(4):708-14     [PubMed PMID: 16487832]


Papafaklis MI,Bourantas CV,Theodorakis PE,Katsouras CS,Naka KK,Fotiadis DI,Michalis LK, The effect of shear stress on neointimal response following sirolimus- and paclitaxel-eluting stent implantation compared with bare-metal stents in humans. JACC. Cardiovascular interventions. 2010 Nov;     [PubMed PMID: 21087755]


Cole OJ, Shehata M, Rigg KM. Effect of SDZ RAD on transplant arteriosclerosis in the rat aortic model. Transplantation proceedings. 1998 Aug:30(5):2200-3     [PubMed PMID: 9723440]

Level 3 (low-level) evidence


Baetta R, Granata A, Canavesi M, Ferri N, Arnaboldi L, Bellosta S, Pfister P, Corsini A. Everolimus inhibits monocyte/macrophage migration in vitro and their accumulation in carotid lesions of cholesterol-fed rabbits. The Journal of pharmacology and experimental therapeutics. 2009 Feb:328(2):419-25. doi: 10.1124/jpet.108.144147. Epub 2008 Nov 20     [PubMed PMID: 19023042]

Level 3 (low-level) evidence


Kandzari DE, Smits PC, Love MP, Ben-Yehuda O, Banai S, Robinson SD, Jonas M, Kornowski R, Bagur R, Iniguez A, Danenberg H, Feldman R, Jauhar R, Chandna H, Parikh M, Perlman GY, Balcells M, Markham P, Ozan MO, Genereux P, Edelman ER, Leon MB, Stone GW. Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis). Circulation. 2017 Oct 3:136(14):1304-1314. doi: 10.1161/CIRCULATIONAHA.117.028885. Epub 2017 Aug 9     [PubMed PMID: 28794001]

Level 1 (high-level) evidence


Camici GG, Steffel J, Amanovic I, Breitenstein A, Baldinger J, Keller S, Lüscher TF, Tanner FC. Rapamycin promotes arterial thrombosis in vivo: implications for everolimus and zotarolimus eluting stents. European heart journal. 2010 Jan:31(2):236-42. doi: 10.1093/eurheartj/ehp259. Epub 2009 Jun 29     [PubMed PMID: 19567381]

Level 3 (low-level) evidence


Huang Y, Venkatraman SS, Boey FY, Lahti EM, Umashankar PR, Mohanty M, Arumugam S, Khanolkar L, Vaishnav S. In vitro and in vivo performance of a dual drug-eluting stent (DDES). Biomaterials. 2010 May:31(15):4382-91. doi: 10.1016/j.biomaterials.2010.01.147. Epub 2010 Feb 26     [PubMed PMID: 20189244]

Level 3 (low-level) evidence


Kang SN, Kim SE, Choi J, Park K, Goo JH, Sim DS, Hong YJ, Kim JH, Joung YK, Lee J, Jeong MH, Han DK. Comparison of phytoncide with sirolimus as a novel drug candidate for drug-eluting stent. Biomaterials. 2015 Mar:44():1-10. doi: 10.1016/j.biomaterials.2014.12.015. Epub 2015 Jan 5     [PubMed PMID: 25617121]

Level 3 (low-level) evidence


Macdonald RG, Panush RS, Pepine CJ. Rationale for use of glucocorticoids in modification of restenosis after percutaneous transluminal coronary angioplasty. The American journal of cardiology. 1987 Jul 31:60(3):56B-60B     [PubMed PMID: 2956845]


Meyer Zu Schwabedissen HE, Begunk R, Hussner J, Juhnke BO, Gliesche D, Böttcher K, Sternberg K, Schmitz KP, Kroemer HK. Cell-specific expression of uptake transporters--a potential approach for cardiovascular drug delivery devices. Molecular pharmaceutics. 2014 Mar 3:11(3):665-72. doi: 10.1021/mp400245g. Epub 2014 Feb 19     [PubMed PMID: 24495124]

Level 3 (low-level) evidence


Lee JJ, Lee JH, Yim NH, Han JH, Ma JY. Application of galangin, an active component of Alpinia officinarum Hance (Zingiberaceae), for use in drug-eluting stents. Scientific reports. 2017 Aug 15:7(1):8207. doi: 10.1038/s41598-017-08410-2. Epub 2017 Aug 15     [PubMed PMID: 28811550]


Hamada N,Miyata M,Eto H,Shirasawa T,Akasaki Y,Nagaki A,Tei C, Tacrolimus-eluting stent inhibits neointimal hyperplasia via calcineurin/NFAT signaling in porcine coronary artery model. Atherosclerosis. 2010 Jan;     [PubMed PMID: 19682688]

Level 3 (low-level) evidence


Siller-Matula JM, Tentzeris I, Vogel B, Schacherl S, Jarai R, Geppert A, Unger G, Huber K. Tacrolimus-eluting carbon-coated stents versus sirolimus-eluting stents for prevention of symptom-driven clinical end points. Clinical research in cardiology : official journal of the German Cardiac Society. 2010 Oct:99(10):645-50. doi: 10.1007/s00392-010-0165-3. Epub 2010 Apr 20     [PubMed PMID: 20405134]


Oh B, Melchert RB, Lee CH. Biomimicking Robust Hydrogel for the Mesenchymal Stem Cell Carrier. Pharmaceutical research. 2015 Oct:32(10):3213-27. doi: 10.1007/s11095-015-1698-y. Epub 2015 Apr 25     [PubMed PMID: 25911596]


Serruys PW, Ormiston JA, Sianos G, Sousa JE, Grube E, den Heijer P, de Feyter P, Buszman P, Schömig A, Marco J, Polonski L, Thuesen L, Zeiher AM, Bett JH, Suttorp MJ, Glogar HD, Pitney M, Wilkins GT, Whitbourn R, Veldhof S, Miquel K, Johnson R, Coleman L, Virmani R, ACTION investigators. Actinomycin-eluting stent for coronary revascularization: a randomized feasibility and safety study: the ACTION trial. Journal of the American College of Cardiology. 2004 Oct 6:44(7):1363-7     [PubMed PMID: 15464314]

Level 1 (high-level) evidence


Acharya G,Park K, Mechanisms of controlled drug release from drug-eluting stents. Advanced drug delivery reviews. 2006 Jun 3;     [PubMed PMID: 16546289]


Rizas KD, Mehilli J. Stent Polymers: Do They Make a Difference? Circulation. Cardiovascular interventions. 2016 Jun:9(6):. pii: e002943. doi: 10.1161/CIRCINTERVENTIONS.115.002943. Epub     [PubMed PMID: 27193905]


Gehman S. Increased risk of restenosis after placement of gold-coated stents. Circulation. 2001 Jul 31:104(5):E23     [PubMed PMID: 11479268]

Level 3 (low-level) evidence


Kastrati A, Schömig A, Dirschinger J, Mehilli J, von Welser N, Pache J, Schühlen H, Schilling T, Schmitt C, Neumann FJ. Increased risk of restenosis after placement of gold-coated stents: results of a randomized trial comparing gold-coated with uncoated steel stents in patients with coronary artery disease. Circulation. 2000 May 30:101(21):2478-83     [PubMed PMID: 10831521]

Level 1 (high-level) evidence


Pinchuk L,Wilson GJ,Barry JJ,Schoephoerster RT,Parel JM,Kennedy JP, Medical applications of poly(styrene-block-isobutylene-block-styrene) (     [PubMed PMID: 17980425]

Level 3 (low-level) evidence


Busch R, Strohbach A, Rethfeldt S, Walz S, Busch M, Petersen S, Felix S, Sternberg K. New stent surface materials: the impact of polymer-dependent interactions of human endothelial cells, smooth muscle cells, and platelets. Acta biomaterialia. 2014 Feb:10(2):688-700. doi: 10.1016/j.actbio.2013.10.015. Epub 2013 Oct 19     [PubMed PMID: 24148751]


Tyler B, Gullotti D, Mangraviti A, Utsuki T, Brem H. Polylactic acid (PLA) controlled delivery carriers for biomedical applications. Advanced drug delivery reviews. 2016 Dec 15:107():163-175. doi: 10.1016/j.addr.2016.06.018. Epub 2016 Jul 15     [PubMed PMID: 27426411]


Jain RA. The manufacturing techniques of various drug loaded biodegradable poly(lactide-co-glycolide) (PLGA) devices. Biomaterials. 2000 Dec:21(23):2475-90     [PubMed PMID: 11055295]


Sung HJ,Meredith C,Johnson C,Galis ZS, The effect of scaffold degradation rate on three-dimensional cell growth and angiogenesis. Biomaterials. 2004 Nov;     [PubMed PMID: 15147819]

Level 3 (low-level) evidence


Xi T, Gao R, Xu B, Chen L, Luo T, Liu J, Wei Y, Zhong S. In vitro and in vivo changes to PLGA/sirolimus coating on drug eluting stents. Biomaterials. 2010 Jul:31(19):5151-8. doi: 10.1016/j.biomaterials.2010.02.003. Epub 2010 Apr 10     [PubMed PMID: 20382420]

Level 3 (low-level) evidence


Pilgrim T, Windecker S. Drug-eluting stent technology: progress beyond the polymer. European heart journal. 2014 Aug 7:35(30):1991-5. doi: 10.1093/eurheartj/ehu224. Epub 2014 Jun 7     [PubMed PMID: 24908391]


Han Y, Xu B, Jing Q, Lu S, Yang L, Xu K, Li Y, Li J, Guan C, Kirtane AJ, Yang Y, I-LOVE-IT 2 Investigators. A randomized comparison of novel biodegradable polymer- and durable polymer-coated cobalt-chromium sirolimus-eluting stents. JACC. Cardiovascular interventions. 2014 Dec:7(12):1352-60. doi: 10.1016/j.jcin.2014.09.001. Epub 2014 Nov 12     [PubMed PMID: 25440887]

Level 1 (high-level) evidence


Hausleiter J,Kastrati A,Mehilli J,Schühlen H,Pache J,Dotzer F,Sattelberger U,Dirschinger J,Schömig A, Impact of lesion complexity on the capacity of a trial to detect differences in stent performance: results from the ISAR-STEREO trial. American heart journal. 2003 Nov;     [PubMed PMID: 14597939]

Level 1 (high-level) evidence


Nakazawa G, Finn AV, John MC, Kolodgie FD, Virmani R. The significance of preclinical evaluation of sirolimus-, paclitaxel-, and zotarolimus-eluting stents. The American journal of cardiology. 2007 Oct 22:100(8B):36M-44M     [PubMed PMID: 17950831]

Level 3 (low-level) evidence


Granada JF, Huibregtse BA, Dawkins KD. New stent design for use in small coronary arteries during percutaneous coronary intervention. Medical devices (Auckland, N.Z.). 2010:3():57-66. doi: 10.2147/MDER.S13494. Epub 2010 Oct 19     [PubMed PMID: 22915922]


Lee JZ, Singh N, Ortega G, Low SW, Kanakadandi U, Fortuin FD, Lassar T, Lee KS. Composite outcomes in 2.25-mm drug eluting stents: a systematic review. Cardiovascular revascularization medicine : including molecular interventions. 2015 Jun:16(4):237-42. doi: 10.1016/j.carrev.2015.03.008. Epub 2015 Apr 9     [PubMed PMID: 25976630]

Level 1 (high-level) evidence


Marroquin OC, Selzer F, Mulukutla SR, Williams DO, Vlachos HA, Wilensky RL, Tanguay JF, Holper EM, Abbott JD, Lee JS, Smith C, Anderson WD, Kelsey SF, Kip KE. A comparison of bare-metal and drug-eluting stents for off-label indications. The New England journal of medicine. 2008 Jan 24:358(4):342-52. doi: 10.1056/NEJMoa0706258. Epub     [PubMed PMID: 18216354]


Bundhun PK, Bhurtu A, Soogund MZ, Long MY. Comparing the Clinical Outcomes between Drug Eluting Stents and Bare Metal Stents in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials. PloS one. 2016:11(4):e0154064. doi: 10.1371/journal.pone.0154064. Epub 2016 Apr 25     [PubMed PMID: 27111304]

Level 2 (mid-level) evidence


Khera S, Villablanca PA, Kolte D, Gupta T, Hasan Khan M, Velagapudi P, Kalra A, Kleiman N, Aronow HD, Abbott JD, Rosenfield K, Drachman DE, Bangalore S, Bhatt DL, Naidu SS. Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis. Cardiology in review. 2018 Nov/Dec:26(6):277-286. doi: 10.1097/CRD.0000000000000192. Epub     [PubMed PMID: 30157064]

Level 1 (high-level) evidence


Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Dangas G, Wong SC, Fahy M, Parise H, Mehran R, HORIZONS-AMI Trial Investigators. Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial. Lancet (London, England). 2011 Jun 25:377(9784):2193-204. doi: 10.1016/S0140-6736(11)60764-2. Epub 2011 Jun 12     [PubMed PMID: 21665265]

Level 1 (high-level) evidence


Iakovou I, Ge L, Colombo A. Contemporary stent treatment of coronary bifurcations. Journal of the American College of Cardiology. 2005 Oct 18:46(8):1446-55     [PubMed PMID: 16226167]


Lai CH, Lee WL, Sung SH, Hsu PF, Chen YH, Chan WL, Lin SJ, Lu TM. Comparison of Bare-Metal Stent and Drug-Eluting Stent for the Treatment of Patients Undergoing Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease - Long-Term Result from a Single Center Experience. Acta Cardiologica Sinica. 2015 Sep:31(5):381-9     [PubMed PMID: 27122897]


Colombo A, Giannini F, Briguori C. Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory? Journal of the American College of Cardiology. 2017 Aug 1:70(5):607-619. doi: 10.1016/j.jacc.2017.05.057. Epub     [PubMed PMID: 28750704]


Hill RA, Boland A, Dickson R, Dündar Y, Haycox A, McLeod C, Mujica Mota R, Walley T, Bagust A. Drug-eluting stents: a systematic review and economic evaluation. Health technology assessment (Winchester, England). 2007 Nov:11(46):iii, xi-221     [PubMed PMID: 17999841]

Level 1 (high-level) evidence


Rinfret S, Cohen DJ, Tahami Monfared AA, Lelorier J, Mireault J, Schampaert E. Cost effectiveness of the sirolimus-eluting stent in high-risk patients in Canada: an analysis from the C-SIRIUS trial. American journal of cardiovascular drugs : drugs, devices, and other interventions. 2006:6(3):159-68     [PubMed PMID: 16780389]


Goeree R, Bowen JM, Blackhouse G, Lazzam C, Cohen E, Chiu M, Hopkins R, Tarride JE, Tu JV. Economic evaluation of drug-eluting stents compared to bare metal stents using a large prospective study in Ontario. International journal of technology assessment in health care. 2009 Apr:25(2):196-207. doi: 10.1017/S0266462309090254. Epub 2009 Mar 31     [PubMed PMID: 19331710]


Kandzari DE, Mauri L, Popma JJ, Turco MA, Gurbel PA, Fitzgerald PJ, Leon MB. Late-term clinical outcomes with zotarolimus- and sirolimus-eluting stents. 5-year follow-up of the ENDEAVOR III (A Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions). JACC. Cardiovascular interventions. 2011 May:4(5):543-50. doi: 10.1016/j.jcin.2010.12.014. Epub     [PubMed PMID: 21596327]

Level 1 (high-level) evidence


Kalra A, Rehman H, Khera S, Thyagarajan B, Bhatt DL, Kleiman NS, Yeh RW. New-Generation Coronary Stents: Current Data and Future Directions. Current atherosclerosis reports. 2017 Mar:19(3):14. doi: 10.1007/s11883-017-0654-1. Epub     [PubMed PMID: 28220461]

Level 3 (low-level) evidence


Puranik AS,Dawson ER,Peppas NA, Recent advances in drug eluting stents. International journal of pharmaceutics. 2013 Jan 30     [PubMed PMID: 23117022]

Level 3 (low-level) evidence


Lee DH, de la Torre Hernandez JM. The Newest Generation of Drug-eluting Stents and Beyond. European cardiology. 2018 Aug:13(1):54-59. doi: 10.15420/ecr.2018:8:2. Epub     [PubMed PMID: 30310472]