As human knowledge increased in PCI, the related technology to this specialty has also evolved7. Plain old balloon angioplasty (POBA) and bare-metal stents (BMS) were developed to-relief ischemia and angina. Despite the potentially significant benefits of these strategies to some patients, they had their complications that became clear with various studies7–10.
Ultimately, supplementary technologies were needed to resolve these issues, which led to the development of drug-eluting stents (DES). DES technology uses a coating of an antiproliferative drug on top of the metal structure of the stents, which causes less stent hyperplasia and stent stenosis compared to BMS. One of the significant effects of DES was that patients with previously difficult diseases, such as those with diabetes or multivesicular disease, were treatable11,12. As a result, more and more challenging lesions became amenable to PCI. Second-generation DES has an extra coating of biocompatible polymer with better endothelial healing. Cobalt-chromium everolimus-eluting stents (second-generation DES) is safer than paclitaxel-eluting stent (first-generation DES) and BMS due to better vascular recovery and re-reendothelialization of stent struts as evidenced in an animal model13. Recent studies show that second-generation DES with biodegradable polymer coating proved to have more efficacy in reducing target-vessel revascularization (TVR), target-lesion revascularization (TLR), in-stent late loss (ISLL), and late-stent thrombosis as compared to BMS. Studies also showed the higher efficacy of DES in the complex lesion than BMS14,15.
Different DES were examined for the post-expansion with larger balloon sizes, which is an essential factor in the quality of coronary stents in previous studies. In a study conducted in 2016, which examined six drug stents with different brands, two stents from Ultimaster and Biomatrix Alpha brands had the highest expansion capacity of 5.8 mm16.
As our results showed, no lateral branch dissection and death were reported in any of the patients. In 2013, Ming et al. evaluated the immediate and long-term efficiencies of stenting in patients with coronary artery branch lesions. They reported that stenting in bifurcation lesions could be achieved with a high success rate and after Five-year clinical follow-up, no significant differences were observed between the groups in terms of unpleasant events, including death, heart attack and arteries restenosis17.
On the other hand, our data have shown that there is a significant difference between TIMI flow degree of the CABG and plaque shift, which can be due to the biodegradable coating technology of abluminal in all types of alpha biomaterials stents that prevent thrombosis, re-occlusion of arteries18.
Similar to this study, Menown et al. had shown promising outcomes for Biomatrix Alpha stents5,18. They had studied clinical evidence characterizing the safety and efficacy of the new CoCr Biolimus-A9 eluting stent in Biomatrix Alpha™ registry5 and reported that propensity-adjusted comparison showed similar clinical outcomes to the BES arm in the LEADERS trial6 for the primary endpoint MACE. Also,, at 2-year follow-up, they established a propensity-adjusted analysis sowing that the thin strut (84–88um) Biomatrix Alpha CoCr-BP-BES was associated with improved clinical outcomes compared with the thicker strut (114–120um) Biomatrix Flex SS-BP-BES18.
Lately, a meta-analysis of 69 randomized drug-eluting stent trials showed that patients receiving stents with ultra-thin struts have lower rates of MI and stent thrombosis19. This promising evidence can help future studies and supplementary technologies to develop sufficient approaches and instruments to CAD management.
Study limitations:
The major limitations of this retrospective cross-sectional study are its relatively modest sample size and the lack of a randomized control arm.