Should ultrathin strut drug eluting stents be considered the new benchmark for novel coronary stents approval? The complex interplay between stent strut thickness, polymeric carriers and antiproliferative drugs

New generation drug eluting stents (DES), differ mainly from first generation DES due to their metallic scaffolds, with thinner struts (<100 μm). These DES have shown excellent safety and efficacy profiles for the treatment of coronary artery disease (CAD) (1-5), with a consequent widespread diffusion in the daily clinical practice. The biomechanical characteristics of cobalt- and platinumchromium alloys has allowed the production of even thinner stent struts, with further improvement of DES mechanical performances (6). However besides the stent strut thickness, the employ of sirolimus as anti-proliferative drug and of bio-resorbable polymers as drug-eluting carriers represent important features of new generation DES. Each of these characteristics was demonstrated to be associated with a reduced late lumen loss (LLL) and minimal hazard of thrombus formation, in both clinical studies (7-9) and metaanalyses (10).