ISCHEMIC HEART DISEASE: Edited by Peter H. StoneThin, very thin, or ultrathin-strut biodegradable or durable polymer-coated drug-eluting stentsBuiten, Rosaly A.a,b; Zocca, Paoloa; von Birgelen, Clemensa,bAuthor Information aDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente bDepartment of Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands Correspondence to Clemens von Birgelen, MD, PhD, Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, The Netherlands. E-mail: [email protected] Current Opinion in Cardiology: November 2020 - Volume 35 - Issue 6 - p 705-711 doi: 10.1097/HCO.0000000000000786 Buy Metrics Abstract Purpose of review The current article will review recently published clinical studies that evaluate very thin or ultrathin-strut drug-eluting stents (DES), focusing on major randomized clinical trials in broad patient populations. Recent findings Multiple randomized trials recently assessed the clinical performance of novel very thin to ultrathin-strut DES. Most randomized trials established noninferiority of the novel device. To date, only one major randomized clinical trial (i.e., BIOFLOW V) showed superiority of an ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent over a very thin-strut durable polymer-coated everolimus-eluting stent in a relatively broad patient population. There are signals that the same ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent may improve clinical outcome in specific patient populations. For example, in the randomized BIOSTEMI trial, 1-year superiority of the ultrathin-strut DES was found in patients presenting with an acute ST-segment elevation myocardial infarction. Yet, substudies of large randomized trials that assessed patients with small-vessel treatment showed equivocal results. Summary Although two randomized trials showed advantages for ultrathin-strut DES, other clinical trials provided no significant evidence that ultrathin-strut DES improve clinical outcome. The question whether ultrathin-strut DES may reduce the repeat revascularization risk following implantation in small vessels is a matter of further debate and future research. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.