Biodegradable polymer biolimus eluting stents – the disappearing stents

Stents have made the work of the interventionalists much easier by providing good vascular scaffolding, reducing abrupt vessel closure and late lumen loss. Drug eluting stents gave restenosis rates much lesser than bare metal stents. But they came with a price – both in terms of cost and delayed healing of the arterial wall and subsequent late adverse events such as stent thrombosis. To counter this problem biodegradable polymer-based drug-eluting stents were developed, which aim to improve safety by avoiding the persistent inflammatory stimulus given by the durable polymers. Now we have the four year follow up from the LEADERS trial comparing the biodegradable polymer biolimus eluting stents with durable polymer sirolimus-eluting stents [The Lancet, Early Online Publication, 9 November 2011 doi:10.1016/S0140-6736(11)61672-3]. The trial was of a non inferiority design and randomized 1707 patients with 2472 lesions. Very late stent thrombosis between one to four years was lower with biodegradable polymer stent compared to the durable polymer stent. The authors concluded that biodegradable polymer biolimus eluting stents are non inferior to durable polymer serolimus eluting stents and may improve long term outcome by reducing the risk of cardiac events associated with very late stent thrombosis.