Is this the end of the ultrathin-strut hypothesis?

From Grüntzig first coronary angioplasty to contemÂporary drug-eluting stents (DES), there has been significant progress in stent technology. A change in the biomaterial used, from stainless steel to cobalt/platinum chromium, has allowed for thinner struts while maintaining radial strength and radiopacity. The strut thickness has been reduced through the generations of thick (>100 μm), thin (70 to 100 μm) to now ultrathin DES (<70 μm)1. Preclinical models and human stented arteries demonstrate that strut thickness impacts medial injury and inflammation, leading to higher degrees of neointimal hyperplasia for thicker-strut stents. In parallel with the improvement in strut thickness, stent polymer technology evolved from durable polymers (DP) to biodegradable polymers (BP). However, BP-DES on a thin-strut platform have been at best non-inferior to current-generation DP-DES, and the promise of a late superiority (after bioabsorption of the polymer) has remained elusive2. On the other hand, clinical trials and meta-analyses have shown the superiority of ultrathin-strut DES over thin-strut DES1. The ultrathin DES have a strut thickness between 50 μm and 65 μm; they use a biodegradable polymer and elute...