Drug-Eluting Stents vs. Bare Metal Stents: Which is Safer?

Q: Drug-Eluting Stents vs. Bare Metal Stents: Which is Safer?

Hello, Fish netizen： After simple balloon angioplasty of the coronary artery, the rate of restenosis is approximately 30% to 40%. <br>If a bare metal stent is placed, the restenosis rate is about 20%. <br>However, if a drug-eluting stent is used, the restenosis rate drops to belo

Drug-eluting stents versus bare-metal stents?

Hello Doctor, my mother underwent balloon angioplasty three years ago due to heart issues.
After her recent follow-up, the doctor feels that her maintenance has not been adequate and recommends placing a stent.
I would like to ask about the differences between drug-eluting stents and bare-metal stents.
As far as I know, health insurance only covers bare-metal stents.
Setting aside the cost, I would like to know if drug-eluting stents are indeed safer and more stable as many recommend.
As her children, we want to choose the best option for our mother.
Thank you.

yú, 20~29 year old female. Ask Date: 2004/11/18

Dr. Zhong Yuxun reply Cardiology

Hello, Fish netizen: After simple balloon angioplasty of the coronary artery, the rate of restenosis is approximately 30% to 40%.
If a bare metal stent is placed, the restenosis rate is about 20%.
However, if a drug-eluting stent is used, the restenosis rate drops to below 5%.
The decision on whether to use a stent and which type of stent to use is a professional consideration that should be made by the attending physician.
A bare metal stent costs around NT$40,000, and some health insurance plans provide coverage.
There are two types of drug-eluting stents, costing NT$100,000 and NT$120,000, neither of which is covered by health insurance.
The most important factors in preventing coronary artery restenosis are ongoing medication management and lifestyle modifications, including controlling blood pressure, blood sugar, and lipid levels, quitting smoking, and increasing physical activity! Dr.
Chung Yu-Hsuan

Reply Date: 2004/11/18

More Info

When considering the choice between drug-eluting stents (DES) and bare metal stents (BMS) for your mother's coronary artery disease, it's essential to understand the differences in their design, efficacy, and safety profiles.

Drug-Eluting Stents (DES) are coated with medication that is gradually released to help prevent the re-narrowing of the artery (restenosis) after the stent is placed. The medications used in DES, such as sirolimus or paclitaxel, inhibit cell proliferation and inflammation, which are key processes in the healing of the artery wall. This means that DES can significantly reduce the risk of restenosis compared to BMS, especially in patients with complex lesions or those at high risk for restenosis.

Bare Metal Stents (BMS), on the other hand, are simply made of metal without any drug coating. While they are effective in providing immediate support to the artery, they do not have the same capacity to prevent restenosis. As a result, patients who receive BMS may require additional interventions, such as repeat angioplasty or stenting, more frequently than those who receive DES.

Safety Considerations:
1. Thrombosis Risk: One of the main concerns with DES is the risk of late stent thrombosis, which is a blood clot that can form in the stent months or even years after placement. This risk is particularly heightened if patients do not adhere to prescribed antiplatelet therapy (usually aspirin and a second antiplatelet agent like clopidogrel) following the procedure. BMS have a lower risk of late thrombosis but a higher risk of restenosis.

2. Duration of Antiplatelet Therapy: Patients with DES typically require a longer duration of dual antiplatelet therapy (DAPT) compared to those with BMS. This is crucial for preventing thrombosis but can increase the risk of bleeding complications.

3. Patient-Specific Factors: The choice between DES and BMS may also depend on individual patient factors, such as the complexity of the coronary artery disease, the presence of diabetes, and the patient's overall health status. For instance, patients with diabetes or those who have had previous stent failures may benefit more from DES.

Cost and Insurance Considerations: While you mentioned that insurance may only cover BMS, it's worth discussing with your healthcare provider the potential long-term costs associated with repeat procedures due to restenosis with BMS. Sometimes, the initial higher cost of DES can be justified by the reduced need for further interventions.

Conclusion: In summary, drug-eluting stents generally offer a safer and more effective option for preventing restenosis compared to bare metal stents, particularly for patients at higher risk. However, the decision should be made collaboratively with your mother's healthcare team, considering her specific medical history, the complexity of her coronary artery disease, and her ability to adhere to the necessary medication regimen post-stenting. Ultimately, the goal is to ensure the best possible outcome for her heart health.

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