A technology evaluation of the Onyx Frontier drug-eluting stent

ABSTRACT

Introduction

Onyx Frontier^TM represents the latest iteration within the family of zotarolimus-eluting stents (ZES), designed for the treatment of coronary artery disease. Approval by the Food and Drug Administration was granted in May 2022, and Conformité Européenne marking followed in August 2022.

Areas covered

We hereby review the principal design features of Onyx Frontier, highlighting differences and similarities with other currently available drug-eluting stents. In addition, we focus on the refinements of this newest platform as compared with previous ZES versions, including the attributes yielding its exceptional crossing profile and deliverability. The clinical implications related to both its newest and inherited characteristics will be discussed.

Expert opinion

The nuances of the latest Onyx Frontier, together with the continuous refinement previously witnessed throughout the development of ZES, lead to a latest generation device ideal for a diverse spectrum of clinical and anatomical scenarios. In particular, its peculiarities will be of benefit in the settings often offered by a progressively aging population, such as high bleeding risk patients and complex coronary lesions.

KEYWORDS:

• Coronary artery disease
• drug-eluting stent
• Onyx frontier
• percutaneous coronary intervention
• zotarolimus

Article highlights

• Onyx Frontier^TM durable-polymer zotarolimus-eluting stent inherited thin struts (as low as 81 μm) with a cobalt shell and platinum-iridium core, circumferential BioLinx^TM polymer and slow drug release from its predecessor, Resolute Onyx^TM.

• Additional nuances in the design of the coronary stent system, including increased catheter flexibility, the Pebax® blend dual flex balloon, and a smaller crossing profile, optimize its deliverability and render Onyx Frontier extremely competitive in the current panorama of drug-eluting stents.

• These new refinements contributed to the creation of a latest generation drug-eluting stent system ideal for the challenges of contemporary percutaneous coronary intervention, including patients at high bleeding risk, acute myocardial infarction, diabetics, complex lesions, large and small vessels.

Abbreviations list

BP	=	bioresorbable polymer
CAD	=	coronary artery disease
DAPT	=	dual antiplatelet therapy
DES	=	drug-eluting stent
DP	=	durable polymer
MI	=	myocardial infarction
PCI	=	percutaneous coronary intervention
PF	=	polymer-free
ST	=	stent thrombosis
TLF	=	target lesion failure
TVF	=	target vessel failure
ZES	=	zotarolimus-eluting stent

Declaration of interest

A Latib serves on the advisory boards of Medtronic, Boston Scientific, and Abbott. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.