Palmaz says the stent future is in bare metal

Dr. Julio Palmaz, who with Dr. Richard Schatz patented the balloon-expandable stent, believes that, while the market for stents has evolved from bare metal stents to drug-eluting stents (DES), the inevitable limitation of DES will be that they lead to inflammatory response and that their real drawback is that they create a barrier between tissue and the metal of the stent itself.

A plenary speaker during the XXX Congresso Nazionale Della Societa Italiana Di Cardiologia Invasiva (GISE), Dr Julio Palmaz (University of Texas Health Science Center, San Antonio) predicted that coatings "of any kind" will prove to be the downfall of drug-eluting stents—even the bioerodable polymers or the coatings used on fully bioerodable stents that today represent the next great hope in DES technology. Pointing to the failure of gold-coated stents back in 2000, Palmaz called on stent manufacturers to "learn from the mistakes of the past."

"Any coating, of any kind, will have the potential to [produce] nonspecific inflammatory changes," he predicted.

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Dr. Palmaz pointed out that, in a bare metal stent, the positive charges of the metal cause the natural formation of oxides that induce healing. The problem with first generation metal stents, he says, is that the constructions of the stents, and their deployment, cause an interruption of the smooth metal surface that lead to an "unhappy" environment surrounding the stent, leading to restenosis. Dr. Palmaz's focus now, through his own company, is to engineer "advanced metallurgical surface technologies" that address this.

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Global stent market, Report #C245.

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