Thin-strut drug-eluting stents in patients with challenging coronary lesions

Patients with symptomatic obstructive coronary artery disease are often treated with percutaneous coronary intervention; a procedure during which the occluded coronary artery is re-opened and a drug-eluting stent (DES) is placed in the narrowed vessel. This dissertation describes the clinical outcome of patients who participated in large-scale multicenter randomized clinical trials and were treated with a modern type of DES. The main clinical outcome included the assessment of safety and efficacy. All-comer patients treated with all four types of DES that were assessed in the trials showed excellent clinical results, until at least three years of follow-up. In specific subgroups of patients, i.e., in patients treated in coronary arteries with a small lumen vessel diameter (<2.5mm) and in patients treated in severely calcified coronary arteries, the thinnest DES and radiographically most visible DES showed the best clinical outcome. Furthermore, three years after stenting, the clinical results of patients treated in bifurcation lesions were encouraging without between-DES differences. In conclusion, modern DES seem to be safe and effective and there might be potential advantages for one stent over another in specific subgroups of patients.