If you have a blocked artery, your doctor may need to open the blockage and restore blood flow using a small mesh tube called a stent. The stent is inserted in your artery during an angioplasty procedure. Until now, stents were permanent. Now there is a fully dissolving stent available to treat blockages.
In the 1990s, doctors began to place a mesh metal tube in arteries. These stents were inserted with a catheter (a long, thin tube). First, a balloon on the catheter was inflated to push the plaque against the artery walls, helping to open the vessel. Then a stent was placed at the site to keep the artery open. However, bare metal stents can cause scar tissue in the treated segment of the artery, which can reduce blood flow.
One of the oldest types of stents, these are not used as much today.
If a doctor uses only the balloon procedure to press the plaque against the artery walls, the artery can re-narrow. Doctors began using metal stents to support the artery and keep it open. Bare metal stents made it more likely that the artery would stay open.
Within a year, some arteries treated with bare metal stents would become blocked due to injury from the stent.2 This type of blockage could cause symptoms similar to those of coronary artery disease. Doctors sometimes had to perform a second angioplasty or implant another stent to clear the artery.2
In 2003, doctors began to use drug-eluting stents, which are coated with a medication. The medicine reduces inflammation and reduces the likelihood of scar tissue forming. Drug-eluting stents greatly reduced the rate of re-blockage. After the medicine is fully dissolved, the metal stent remains in the person's artery for life.
This is the most commonly used type of stent. It can be used to treat simple and complex conditions, and it comes in the largest range of sizes.
Drug-eluting stents reduce the blockage caused by scar tissue.
Drug-eluting stents remain in the blood vessel permanently, which carries some long-term risk.3-6 Sometimes tissue buildup requires a second treatment to fully open the artery. Patients also face the risk of future blockages due to metal stents. To help address this risk, doctors prescribe blood-thinning medicine that patients may have to take long term. Having metal in the heart permanently may also limit treatment options if you need another procedure in the future.
Like drug-eluting stents, this stent has a medicine that is released to reduce inflammation. The difference with dissolving-coating stents: the medicine is released when the coating—which binds the medicine to the metal stent—dissolves.
This is another drug-eluting stent option that doctors may choose to use.
This is one of the most recent types of stents approved by the FDA. In many ways it acts like a drug-eluting stent.
Though the coating that binds the medicine to the stent dissolves over time, this option still leaves a permanent metal stent in the artery. With this stent, like other drug-eluting stents, sometimes tissue build-up requires a second treatment to fully open the artery. This type of stent has not been available as long as other drug-eluting stents. So it has not been studied in long-term research as much as drug-eluting stents that are today considered "standard of care." Research has shown that some of the most commonly used drug-eluting stent coatings have been proven to be safer than dissolving-coating stents.7-9 More studies are needed to see the long-term outcome for this type of dissolving-coating stent.
The fully dissolving stent is as effective as current drug-eluting stents for treating blocked heart arteries, and both types of stents are similarly safe. Like drug-eluting stents, the fully dissolving stent is coated with medicine to reduce scar tissue. But unlike a permanent stent, this new stent slowly dissolves in about 3 years. Stents do not need to stay in the artery forever, but they are needed to support the vessel during the first three months after a blocked artery has been opened. After that, the artery can remain open on its own.
This is the most recent type of stent available. Because it fully dissolves and is not a permanent implant, it is a new category of stent. It does not yet come in the full range of sizes, and it may not be used to treat all types of blockages.
As the stent dissolves, it breaks down into water and carbon dioxide, which are naturally present in the body. The artery is restored,* which allows the treated part of the artery to move1 and flex like a natural vessel. And when an artery flexes as needed for blood flow, it can provide your heart with the oxygen it needs.
With no foreign object left behind,** you can look forward to a future with renewed possibilities.
Fully dissolving stents have a good safety record, but some doctors may not know about this new stent. It’s important for patients to talk with their doctor about which stent is right for them. Because this type of stent is new, it has not been studied over long periods of time. More research is needed to know about its long-term outcomes.
1. Serruys PW et al. ABSORB Cohort B Presentation. TCT 2015.
2. Hamid H et al. Mcgill J Med. 2007;10:105–111.
3. Windecker S. RESOLUTE All Comers 5 Year. EuroPCR. 2014.
4. Gada H et al. SPIRIT III 5 Year. J Am Coll Cardiol Intv. 2013;6:1263-1266.
5. Smits P. COMPARE 5 Year. TCT. 2013.
6. Serruys PW. LEADERS 5 Year. TCT. 2012.
7. Puricel S et al. J Am Coll Cardiol. 2015;66(15_S).
8. Fajadet J. PLATINUM PLUS 30-Day Poster. TCT. 2013.
9. Serruys PW et al. RESOLUTE All Comers. N Engl J Med. 2010;363:136-146.
*Absorb improves coronary luminal diameter, restores blood flow and enables movement of the treated vessel. Source: Absorb GT1 IFU.
**Absorb dissolves completely—except for 4 small platinum markers that show up on a scan so that doctors can always see exactly where the stent was placed.