Biodegradable stents : "fulfilling the mission and stepping away".

In 458 BC, a prominent Roman leader named Lucius Quintius Cincinnatus was unique in his behavior. Cincinnatus served his country when he was needed and, after fulfilling his duty, he returned to his private life.1 We now see a new medical device, a biodegradable stent, that mimics this historical figure. The 2 main functions of a stent, treatment of dissection and prevention of restenosis, refer to 2 events that occur and progress in a set frame of time. Coronary dissections are effectively contained by stent insertion and undergo a healing process, with the majority of cardiac events occurring in the first 6 months.2 In-stent restenosis also occurs within the first 6 months.3 Therefore, a permanent prosthesis that is in place beyond this initial period has no clear function. Besides lacking a well-defined function, are there any negative aspects related to the presence of a permanent coronary implant? Zidar et al4 stated that one of the main reasons to develop a biodegradable stent was the short-term need for a stent and the potential long-term complications of metal stents. Kimura et al3 demonstrated, with an extended angiographic follow-up of 3 years, that the presence of a metallic stent does not seem to be associated with lesion progression or accelerated atherosclerosis of the treated site after 6 months. In fact, late improvement in luminal diameter seems to occur between 6 months and 3 years. The Belgian Netherlands Stent Study (BENESTENT I) recently extended its follow-up to 5 years and demonstrated a sustained and persistent benefit of the stent.5 If no demonstrable complications exist with a permanent intracoronary implant, can the question be turned around by asking, “What are the benefits of not having a permanent coronary implant?” Two answers can be given. 1. Coronary stenting freezes recoil, …