The system involves a reverse cone stent that is placed in the carina, and two additional stents that can be placed in the main branch and side branch as needed. In clinical testing so far, the target lesion revascularization rate in the bifurcation has been 7.5%.
“This looks like the best stent so far for bifurcations,” Dr. Stone said.
The fifth new drug-eluting stent, which uses paclitaxel, delivers the drug in a novel way. The device, which is made by Conor Medsystems, first used a steel stent with a bioabsorbable polymer that is placed in dozens of small wells drilled on the stent surface.
The positioning of the wells allows for the delivery of different drugs to the endothelial surface or into the coronary lumen, and the total doses and elution rates can also be manipulated.
A study with 191 patients identified two paclitaxel doses that worked best: 10 mcg and 30 mcg, both delivered over 30 days.
In more recent studies, investigators have used a cobalt and chromium stent, the Costar, that is more flexible and durable than the steel stent.
In a study with 282 patients, the 10-mcg dose worked best with the Costar stent. This dose and stent are now being compared with the paclitaxel-eluting Taxus stent in a study designed to involve about 1,500 patients.