Platinum chromium everolimus-eluting stents for the treatment of (complex) coronary artery disease; from SYNERGY™ to the MEGATRON™

ABSTRACT

Introduction

The introduction of drug-eluting coronary stents (DES) into clinical practice in 2002 represented a major milestone in the treatment of obstructive coronary artery disease. Over the years, significant advances in polymer coating and in antiproliferative agent technology have further improved the safety and clinical performance of newer-generation DES.

Areas covered

Development of platinum chromium (PtCr) alloys with high radial strength and high radiopacity have enabled the design of new, thin-strut, flexible, and highly trackable stent platforms, while simultaneously improving stent visibility. These advances have facilitated complex percutaneous treatment of a diverse population of patients in clinical practice. This review will provide an overview of the evolution in PtCr everolimus-eluting stents from PROMUS Element™ to SYNERGY™ to the recently introduced SYNERGY MEGATRON™. The clinical data will be summarized and put into perspective, especially focusing on the role of the SYNERGY™ and MEGATRON™ platforms in the treatment of complex coronary artery disease and high-risk patients.

Expert opinion

The SYNERGY™ stent demonstrates favorable clinical efficacy and safety outcome data, and whilst the clinical data on MEGATRON™ are sparse, early experience is promising. The specific overexpansion capabilities, visibility, and radial strength of the MEGATRON™ are attractive features for complex coronary interventions.

KEYWORDS:

• Platinum chromium
• synergy
• megatron
• DES
• left main PCI

Article highlights

• The SYNERGY™ and MEGATRON™ stent platform consists of PtCr ultrathin/thin struts eluting everolimus from a thin abluminal bioabsorbable polymer coating. The SYNERGY™ BP stents come in sizes from 2.25 to 5.0 mm, SYNERGY MEGATRON™ from 3.5 to 5.0 mm.

• The SYNERGY™ and MEGATRON™ represent an iterative progression of platinum chromium DES, with each successive generation implementing changes to improve device performance, efficacy, and safety.

• Results of the SYNERGY™ platform in the treatment of simple and complex coronary artery disease demonstrate favorable clinical efficacy and safety outcome data.

• Benchmark testing of the SYNERGY MEGATRON™ shows high radial and axial strength with increased overexpansion capability. The stent has been proposed for left main and proximal lesions, including complex PCI lesions. Clinical outcome data are sparse, but first available data are promising and would suggest that the SYNERGY MEGATRON™ will have an important role to play in advancing the boundary of percutaneous treatable CAD.

• Novel device-based and pharmacological approaches are still needed to further alleviate the long-term occurrence of stent-related events and further improve the outcomes of patients with CAD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties. Johan Bennett has received institutional consultancy fees from Boston Scientific, Medtronic, Elixir and Biotronik AG.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.