The pace of innovation in the interventional management of coronary artery disease has been impressive. First generation interventions included balloon angioplasty, quickly followed by angioplasty and placement of a stent to hold the vessel open. The third generation was heralded with the introduction of drug eluting stents. In each case, new technology was developed in response to what was perceived to be the failings of the existing approach. So, it is not surprising that a bioabsorbable stent would represent the fourth generation intervention. While the forthcoming case series mentioned in this story will add to previous data suggesting benefits from this new approach, only a randomized trial comparing a bioabsorbable and non-bioabsorbable stents will provide convincing evidence of its value.
We were happy to see some attention to the potential cost of the stent and in comparison to the existing drug eluting stents. In addition, the story provided information on the market size at the present time.
The story really does not provide a crisp rationale for a bioabsorbable stent. An important limitation of existing stents is that they are associated with increased risk of clots. The absorbable stents are designed to help with this problem, but the story doesn’t communicate this. It only refers to the possibility that the new stents may also cause clots in some people. The comments of the Abbott spokesperson aside, the reader is not provided with any idea of how often the existing stents create difficulties and why the Abbott stent will alleviate the problem.
We liked the fact that the potential downsides of the bioabsorbable stent were included in the story. The story notes that the bioabsorbable stent is thicker and may require patients to be on potent anti-clotting drugs, thus exposing the patient to a risk of bleeding. The story also notes that previous studies have shown a low rate of complications. We would have liked to have seen some information about the complications seen.
The results of the latest study examining the bioabsorbable stent haven’t yet been released, and the story does not delve into optimistic speculation about what the study may show. We liked the way in which the theoretical advantages are stated and that the many unknowns and questions that remain are included. The story could have provided a bit more information on the previous studies of bioabsorble stents that are alluded to in the story, especially since there are no new data to discuss.
There was no disease-mongering in the story.
The statements made by a company representative are counterbalanced by comments from Dr. Virmani, an independent expert in coronary artery disease and a very outspoken individual.
We would have liked to have a comment or two on the parallel developments ongoing in this field. Coronary artery disease is more than a singe blockage. It is a systemic disease that is progressive unless systemic interventions are employed. Aggressive medical therapy is now viewed as an essential element to ongoing care and should have been included for completeness
The story makes it clear that while the absorbable stent is available in Europe, Abbot will not be seeking approval for marketing in the United States until 2015.
The idea of a bioabsorbable stent is not new or unique to Abbott. The concept was proposed in the early 1990’s and the other players are also working on their own version. Although the story alludes to the fact that competitors might seek to follow Abbott’s lead, it doesn’t convey that other companies are already quite far along in their research.
Since the story quotes an unaffiliated expert in the field of cardiac pathophysiology, it is clear that it did not rely solely on a press release. We do wonder, however, why the story ran prior to the issuance of the preliminary results on the new study.