Fathersson

Good question. I'm betting it's largely marketing and cost.

There have been numerous papers published looking at the efficacy of the Cypher (sirolimus coated) and Taxol (paclitaxel coated) stents (European Heart Journal, JAMA, Journal of the American College of Cardiology). It seemed that initially the cypher stents performed slightly better in preventing restenosis, but the most recent papers indicate that edge is pretty thin and both drugs seem to be very nearly equally effective (although amongst the smallest diameter stent'able arteries, the cypher stent still holds a slight edge - don't know why the vessel size makes a difference though).

This 2005 piece at the New England Journal of Med ([url]http://content.nejm.org/cgi/content/full/353/7/724[/url]) summarizes:

"The data overall, from randomized clinical trials and from registries, suggest that the currently available sirolimus-eluting stents provide an angiographic and clinical edge over the currently available paclitaxel-eluting stents. In contrast, the currently available paclitaxel-eluting stent holds an edge on availability, deliverability, and cost. Whereas a large-scale, randomized trial may help settle this score more definitively, the testing of second-generation drug-eluting stent platforms, with various stent struts, polymers, and drugs is already well under way."

Of course the cypher stent won FDA approval a year before the taxol stent. There's a web page at Brown University that mentions that "In less than one year after Cypher won government approval, one in every 1,500 Americans was wearing a Cypher stent." I'm sure doctor's are like everyone else, if they learned using one device that seems to work well, they are probably reluctant to change without compelling justification, so the early start by Johnson and Johnson may be a big factor.

The cath lab where I had my stents put in (Cypher) also does use the Taxol stents as well. I'll have to ask sometime if each cardiologist only uses one or the other, and if so, why (since the facility has the tools for both, and obviously buys both)?

edit:

P.S. this is the most recent literature I could find:

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=C itation&list_uids=16458128[/url]

Sirolimus-eluting versus paclitaxel-eluting stent implantation for the percutaneous treatment of left main coronary artery disease: a combined RESEARCH and T-SEARCH long-term analysis. Journal of the American College of Cardiology, Volume 47, Issue 3 , 7 February 2006, Pages 507-514
"CONCLUSIONS: In consecutive patients undergoing percutaneous LM intervention, PES may perform closely to SES both in terms of angiographic and long-term clinical outcome.'