EuroPCR 2017: DESSOLVE III – crystal clear benefit?

Reported from EuroPCR 2017, Paris

The continually evolving BVS story reminds us how dependable the durable polymer Xience stent platform remains for the treatment of patients with coronary artery disease. In the DESOLVE III trial, the fully absorbable polymer stent containing a micro-crystalline form of sirolimus (MiStent) was pitched against Xience for noninferiority at 12 months. The unique crystalline formulation permits continued drug elution for ~9 months despite early absorption of the polymer after 3 months. The rationale for this stent design is that earlier resorption of the coating may reduce the inflammatory response implicated in vessel restenosis

This latest addition to the DESSOLVE family of studies is the first to adopt a randomised trial design in a realworld, all-comers population of 1398 patients. The primary endpoint of target lesion failure was numerically lower with the novel stent device, occurring in 5.8% and 6.5% of patients randomised to MiStent and Xience, respectively. Furthermore, encouraging data on the very low event rates of definite/probable stent thrombosis (<1%) observed with both metallic stent platforms was also reported.

Perhaps a victim of its own success, with such low event rates, the demonstration of superiority for any new stent device seems implausible to achieve.  However, as the panel were quick to point out, the favourable separation in event curves for MiStent seen towards the end of the 12 months may translate into a more ‘crystal clear’ benefit in the future.

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