Question: What type of drug-coated stent is best? Should I request a specific type?
Answer: Right now, there are two types of drug-eluting stents approved in the United States.
They slightly differ in their metallic construction, but they have different drugs. One is called paclitaxel and the other is called sirolimus. These are very fancy terms, but they essentially do the same things, and that is: they inhibit the tissue from growing.
One inhibits the tissue a little bit more than the other, and there have been head-to-head studies that have looked to see if there are major differences between the two.
None of the studies have been sufficient for us to know for sure if one of these is safer or more effective than the others, so, for right now, for most practical purposes, these two are fairly equivalent.
There will be new drug-eluting stents that will be approved within the United States, hopefully two new versions in 2008, both of which are quite different.
One actually has more tissue growth, but some studies have suggested in the long-term this may be very, very safe.
The other one is actually very, very effective at inhibiting the tissue from coming back, and some of the early studies suggest that it also may offer a long-term safety advantage.
But these two new stents have not been used nearly as much as the two older versions, and it will take us many hundreds of thousands of patients, and many years of follow-up, before we know for sure if one is clearly better than the other.