Wednesday, April 04, 2012


Now that the 1 care thing has quieten down, I have more time to read.
I was impressed ( after the last posting ), that DES have improved a lot, even without the bio-degradeable metallic scaffolding, that will probably come to us after the second quarter.
In the 10th April, Journal of the American College of cardiology, Dr Clemens Von Birgelen of Thoraxcentrum Twente, Netherlands published their TWENTE study, comparing the performance of the two most popular second generation DES currently in the market. They studied the performance of the Xience V ( Abbott Vas ) and the Endeavor Resolute ( Medtronic International ), in 1392 patients. These patients all had complex CAD, with about 50% stable CAD and 50% NSTEMI. More then 70% of the lesions were type B /C. half od them received the Endeavor stent and the other half the Xience V stent.
At the end of 12 months, there was no difference in the MACE rates ( death, MI and TLR ) between the two groups ( 8.2 / 8.1 ). There was also no difference in stent thrombosis rates at the end of 1 year ( 0.58% / 0% ).
It looks like the two popular second generation DES are equivalent in their performance. This is the second large study to show this. We saw this earlier with the " Resolute all comers study " too.
It is safe to say that the first generation Cypher and Taxus are confined to the realms of history. The second generation Xience V and Endeavor Resolute and maybe the Biomatrix stent, are the workhorses in most labs. I hear that the Boston Scientific - Element stent is also popular because it is more opaque and more deliverable. I have not had any experience with it.
added to these are the Chinese stents which have been shown in some studies to be just as good as the second generation DES. I also have not had any experience with them. My experience is currently with the Endeavor Resolute and the Xience V / Xience Prime stent, and I can say that they are very good. we see restenosis so rarely now, even in very tough lesions. And they are quite deliverable too.

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