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In panel discussion, experts predict bright future for newest-generation stents
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In a recent webinar, a panel of four medical experts expressed optimism for the long-term prospects of two new stents with bioabsorbable technologies approved by the FDA within the past year.
“The beauty of these technologies is that they are evolving,” said Jeffrey Moses, MD, the director of the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center. “In a year or two, [clinicians] will be operating on much firmer ground. There [are] a plethora of data coming.”
The session, sponsored by Boston Scientific, focused on three issues: bioabsorbable polymer drug-eluting stents (Synergy, Boston Scientific) vs. fully bioresorbable scaffolds (Absorb, Abbott Vascular); patient selection criteria; and postprocedural protocol.
Jeffrey Moses
Moving quickly
Elizabeth Holper , MD, MPH, FACC, the chief clinical quality officer and medical director of interventional cardiology research at The Heart Hospital Baylor Plano, Texas, said stent-related science has expanded rapidly.
“We’re talking about first-generation technology (bare-metal stents) vs. third generation,” she said. “Right now, [the newer stents] should be considered ‘best in class.’ There’s a good level of enthusiasm in the U.S. based on the longer-term results and experience of our European counterparts.”
Michael Rinaldi, MD, FACC, FSCAI, a cardiologist and medical director of clinical research at Sanger Heart & Vascular Institute in Charlotte, North Carolina, highlighted the potential downfalls of physicians using the new-generation stents.
Michael Rinaldi
“The ... struts [of Absorb] are thick in both depth and width, which necessitates a different [implantation] technique,” Rinaldi said. “This is potentially an issue.”
Moses said, “There’s a learning curve, an adjustment that has to made by operators. In the U.S., that’s a work in progress.”
Lowered costs
Robert A. Byrne, MB, BCh, PhD, FESC, a cardiologist at Deutches Herzzentrum and medical director of the ISARESEARCH Centre, both in Munich, said the field has made significant strides, and embracing the cutting-edge technology should lead to eventual financial benefits.
Robert A. Byrne
“[DES] have turned into a ‘sweet spot’ in contemporary practice as far as treating all lesion types,” he said. “[With Synergy and Absorb], the long-term cost will not be a huge consideration. As bioabsorbable and bioresorbable technology becomes more established, the price will come down.”
Rinaldi said there should be a cautious yet forward-looking approach to the implementation of fully bioresorbable technologies.
“We, in medicine, try to be data-driven,” he said. “We, as clinicians, struggle with making thoughtful decisions within the ‘art’ of medicine. If we wait for the large clinical data of randomized trials, we’ll always be behind the cutting edge of technology.”
Byrne said European guidelines “have been progressive. As we look to the future, [hopefully] industry and academia can develop better stents.”
Moses said operators should use their clinical judgment for each candidate for the new technologies until long-term data are available.
“As a clinician, work on your intuition,” he said. “Use preclinical data and make the best decision for your patient.”
Holper said the new technologies should enhance patient safety in the long run.
“We’ve seen a huge phase shift,” she said. “There’s no doubt these [new] stents are safer than [BMS]. Anytime we have the opportunity to embrace new technology, it turns us back into good physicians and interventionists. The patients are the ones who benefit.” – by James Clark
Disclosures: Byrne reports receiving lecture fees from B. Braun Melsungen, Biotronik and Boston Scientific and institutional research grants from Boston Scientific and HeartFlow. Holper reports serving on a medical advisory board for Boston Scientific. Moses reports consulting for Abbott and Boston Scientific and serving as chair of the steering committee for a trial sponsored by Keystone Heart. Rinaldi reports consulting for Boston Scientific and past unpaid consulting for Edwards Lifesciences.