Drug-eluting stents (DES) have been the gold standard in interventional cardiology since their development over a decade ago. Today, DES offer exceptional clinical evidence including lower in-stent restenosis (ISR) rates compared to bare-metal stents (BMS). However, late stent thrombosis (LST) remains a concern with DES as some clinical evidence would suggest higher LST rates compared to BMS. Thus, many competitors are seeking to address this concern with the goal of generating product differentiation and commanding a larger share in this increasingly saturated market.
First-generation DES are particularly under scrutiny for the higher rates of LST despite their wide adoption. This is a result of the polymers currently being used to deliver the drug, which can cause these complications after prolonged contact with the artery walls. Today, next-generation DES feature new polymers with reduced LST rates, biodegradable polymers, and in some cases, polymer-free systems to tackle the LST problem. This is not to be confused with bioresorbable stents, a technology first developed by Abbott Vascular. I'm talking about stents that continue to stay in the arteries well after the drug has been delivered. These products have recently been commercially available in regions such as Europe where new technologies are typically first to be adopted. So the question remains: have the efforts of second-generation DES developers paid off?
I turn to Marketrack, our ongoing brand-level purchase and market data product, to understand how these devices are being used in the real world. Looking at the past couple of years, it seems that the adoption has plateaued in Europe after the initial launch and excitement for the technology. More importantly, despite the increased adoption of DES, next-generation stents that offer biodegradable polymers or are polymer-free are not necessarily contributing to this growth.