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Written by Mary Marschner
Spoon Feed
A new third-generation stent, called the Firehawk, was non-inferior to second-generation drug-eluting stent (DES) after a year and shows promise to reduce long-term stent restenosis.
Synopsis
This randomized controlled trial (TARGET-IV NA) evaluated the safety and efficacy of a novel low-dose sirolimus-eluting biodegradable polymer stent (LD-SES) compared to second-generation durable polymer drug-eluting stents (DP-DES) in patients undergoing percutaneous coronary intervention. Among 3,800 participants, the primary endpoint of target lesion failure at 12 months was noninferior for LD-SES (6.1%) versus DP-DES (6.3%; hazard ratio [HR] 0.98, 95% CI: 0.80–1.20). Rates of stent thrombosis were also similar (0.6% vs. 0.5%). Limitations include short follow-up and lack of long-term data on biodegradation. The findings suggest LD-SES is a safe and effective alternative to DP-DES for coronary intervention. (AI-assisted)
Firehawk stent – great name with potential
This study prompted a deeper dive into coronary artery disease and stenting practices. To review, we’ve progressed from angioplasty to bare-metal to drug-eluting stents (DES) for acute coronary syndrome or symptomatic coronary artery disease. The goal is to open a diseased vessel and maintain patency as it incorporates the stent. DES, metal stents with drug-infused polymer coatings, prevent short-term restenosis and require dual antiplatelet therapy (DAPT) for 6–12 months. Complications like late thrombosis or restenosis may require re-stenting, often driven by inflammation from the polymer, drug, or vessel rigidity. The Firehawk stent, with a biodegradable polymer and lower sirolimus dose, aims to reduce hypersensitivity, delayed healing, and impaired neo-intimal coverage. Designed as a 1-year noninferiority trial against second-generation DES, it performed well, but lacks long-term data. Future studies are needed to evaluate superiority over 5–10 years. For now, stents continue to evolve, but 1 year outcomes and DAPT remain unchanged.
Source
Randomized Comparison of Novel Low-Dose Sirolimus-Eluting Biodegradable Polymer Stent vs Second-Generation DES: TARGET-IV NA Trial. J Am Coll Cardiol. 2024 Oct 24:S0735-1097(24)09966-2. doi: 10.1016/j.jacc.2024.10.074. Epub ahead of print. PMID: 39480379
