The Ultimate Guide to Drug-Eluting Stents (2024/2025): A Comprehensive Spec Comparison

Welcome to the definitive guide for interventional cardiologists, cath lab professionals, and anyone involved in Percutaneous Coronary Intervention (PCI). Choosing the right Drug-Eluting Stent (DES) is critical for successful outcomes, and this article provides a detailed, side-by-side comparison of the leading DES products available.

What is a Drug-Eluting Stent (DES)?

A Drug-Eluting Stent (DES) is a small, expandable mesh tube used in Percutaneous Coronary Intervention (PCI) to treat narrowed or blocked coronary arteries. After an angioplasty balloon expands the vessel, the DES is deployed to act as a scaffold, preventing vessel recoil and sealing dissections.

As a foreign object, a stent can sometimes trigger thrombosis (blood clots) or in-stent restenosis (the re-narrowing of the artery due to tissue growth over the stent). To combat this, DES are coated with a medication (drug) that is slowly released (eluted) to inhibit tissue overgrowth. Each manufacturer has developed unique platforms with distinct drugs, polymers, and stent materials. This guide will help you navigate these differences.

Head-to-Head: Drug-Eluting Stent Specifications

Here we break down the technical specifications of the major DES platforms.

1. XIENCE Skypoint™

Available Sizes:

• 2.25mm: 8, 12, 15, 18, 23, 28, 33, 38mm
• 2.50mm: 8, 12, 15, 18, 23, 28, 33, 38, 48mm
• 2.75mm: 12, 15, 18, 23, 28, 33, 38mm
• 3.00mm: 8, 12, 15, 18, 23, 28, 33, 38, 48mm
• 3.25mm: 12, 15, 18, 23, 28, 33, 38mm
• 3.50mm: 8, 12, 15, 18, 23, 28, 33, 38, 48mm
• 4.00mm: 8, 12, 15, 18, 23, 28, 33, 38, 48mm
• 4.50mm: 15, 23mm
• 5.00mm: 15mm

2. SYNERGY™ XD

Available Sizes:

• 2.25-2.75mm: 12, 16, 20, 24, 28, 32, 38mm
• 2.50-4.00mm: Adds 48mm length
• 3.00-3.50mm: Adds 8mm length

Resolute Onyx™

Available Sizes:

• 2.25mm: 12, 15, 18, 22, 26, 30mm
• 2.50-4.00mm: 8, 12, 15, 18, 22, 26, 30, 34, 38mm

Ultimaster™ Nagomi™

Available Sizes:

• 2.25-4.00mm: 12, 15, 18, 24, 28, 33, 38mm
• 2.50-3.00mm: Adds 44, 50mm lengths

Coroflex® ISAR NEO

Available Sizes:

• 2.25-4.00mm: 9, 12, 16, 19, 24, 28, 32, 38mm

BIOFREEDOM™ Ultra

Available Sizes:

• 2.50-4.00mm: 9, 14, 19, 24, 29, 33, 36mm

Orsiro® Mission

Available Sizes:

• 2.25-4.00mm: 9, 13, 15, 18, 22, 26, 30, 35, 40mm

COMBO® Plus

Available Sizes:

• 2.50-3.00mm: 9, 13, 15, 18, 23mm
• 3.00-3.50mm: Adds 28, 33mm lengths

A Brief History of Coronary Stents: From Bare Metal to Bioresorbable

The journey of the coronary stent is a remarkable story of innovation, driven by the need to solve the fundamental problem of restenosis (the re-narrowing of an artery after angioplasty). Understanding this evolution provides crucial context for appreciating the advanced technology of today’s DES.

• The Age of Balloon Angioplasty (1977 onwards): Before stents, Andreas Grüntzig performed the first coronary angioplasty, using only a balloon to widen a blocked artery. While revolutionary, it had major limitations: acute vessel closure (the artery collapsing immediately) and high rates of restenosis within months.
• The First Generation: Bare-Metal Stents (BMS) (mid-1980s – 1990s): The invention of the Bare-Metal Stent (BMS), typically made of stainless steel, was a monumental leap. These simple mesh scaffolds effectively eliminated acute vessel closure and reduced restenosis rates compared to balloon angioplasty alone. However, a new problem emerged: the stent itself, as a foreign body, could provoke an aggressive healing response, leading to in-stent restenosis from excessive tissue growth (neointimal hyperplasia).
• The Second Generation: The Dawn of Drug-Eluting Stents (DES) (Early 2000s): To combat in-stent restenosis, the first generation of DES was created. These stents were coated with a durable polymer that eluted powerful anti-proliferative drugs (like Sirolimus and Paclitaxel). Products like the Cypher® (Sirolimus-eluting) and TAXUS™ (Paclitaxel-eluting) stents dramatically reduced restenosis rates to single digits. However, concerns later arose about the long-term presence of the durable polymer, which was linked to chronic inflammation and a small but significant risk of late stent thrombosis.
• The Third Generation: Enhancing Safety and Performance (Late 2000s – 2010s): The next wave of innovation focused on improving safety and performance. This era brought:
  • More Biocompatible Durable Polymers: Polymers like the fluoropolymer on the XIENCE family of stents showed improved safety profiles.
  • Thinner Struts: Stents made from advanced alloys like Cobalt-Chromium and Platinum-Chromium allowed for much thinner struts, improving deliverability and promoting faster healing.
  • Bioabsorbable Polymers: Stents like SYNERGY and Ultimaster were introduced. Their polymer coating dissolves after the drug has been delivered, leaving a bare-metal stent behind and potentially reducing long-term inflammation.
• The Fourth Generation and Beyond: Polymer-Free and Bioresorbable Scaffolds: The quest for the “perfect” stent continues. This generation includes:
  • Polymer-Free DES: Stents like BIOFREEDOM and Coroflex ISAR NEO elute their drug directly from the stent surface, completely eliminating any polymer-related risks.
  • Bioresorbable Vascular Scaffolds (BVS): The concept of a stent that performs its function and then completely disappears over time (like the Absorb™ scaffold) was a major focus. While early iterations faced challenges, the “leave nothing behind” philosophy continues to drive research and development.

This constant cycle of identifying a problem and engineering a solution is what makes interventional cardiology such a dynamic field, and it’s why today’s physicians have such a sophisticated and diverse toolkit to treat coronary artery disease.

Key Considerations When Choosing a DES

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While the tables above provide raw data, the choice of a DES involves clinical judgment based on several factors:

• Polymer Type (Bioabsorbable vs. Durable): Bioabsorbable polymers (e.g., SYNERGY, Ultimaster) are designed to disappear after the drug is eluted, leaving behind a bare-metal stent. This is theorized to reduce long-term inflammation. Durable polymers (e.g., XIENCE, Resolute Onyx) have a long track record of safety and efficacy. Polymer-free stents (e.g., Coroflex, BIOFREEDOM) aim to eliminate polymer-related risks altogether.
• Strut Thickness: Thinner struts may improve deliverability in complex and tortuous anatomy and are linked to lower restenosis rates. Thicker struts provide greater radial strength, which can be beneficial in calcified or fibrotic lesions.
• Stent Material: Cobalt-Chromium (CoCr) and Platinum-Chromium (PtCr) are the most common alloys, offering a good balance of strength and visibility. The platinum core in Resolute Onyx and the PtCr alloy in SYNERGY enhance radiopacity, making them easier to see under fluoroscopy.
• Drug Type: While different “-olimus” drugs are used, they belong to the same class (mTOR inhibitors) and have demonstrated excellent anti-proliferative effects. The choice often comes down to the performance of the overall stent platform rather than the drug alone.

Disclaimer

This article is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The selection of any medical device should be made by a qualified healthcare professional based on their clinical judgment and the specific needs of the patient.

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