Coronary Artery Stents: Advances in Technology

Abstract

The introduction of percutaneous coronary intervention (PCI) in the late 1970s revolutionized the management of stable and unstable coronary artery disease, providing an effective, quick, safe, and increasingly widely available method for coronary revascularization for many patients. Rapid development in this field led to the introduction of a number of new technologies, including intracoronary stents that have resulted in improved efficacy and long-term safety. In this manuscript we review the experience with the 2 major available classes of stents (bare metal [BMS], drug-eluting [DES]) and describe the delivery systems for these stents. An evidence review of the large trial data comparing balloon angioplasty, BMS, and DES demonstrates the incremental advances over time, with the latest generation of DES achieving the lowest rates of restenosis, stent thrombosis, and recurrent myocardial infarction. In addition, we provide an overview of the latest developments in stent technology, including the introduction of bioresorbable stents and new stent delivery systems. These latest advances are hoped to further improve outcomes while reducing costs due to a reduction in the need for future procedures and hospitalizations due to recurrent coronary disease.

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

“…5 Since the introduction of PTCA by Dr Andreas Gruntzig in 1977, PTCA enjoyed numerous notable advances over the few decades which has greatly improved its success rate with a better safety profile. 27 This improvement becomes more evident after the introduction of drug-eluting stent (DES) which has drastically decreased the rate of restenosis of PTCA. [27][28][29][30] Given the advances, whether PTCA could replace CABG as an ideal treatment modality, remains unknown.…”

“…27 This improvement becomes more evident after the introduction of drug-eluting stent (DES) which has drastically decreased the rate of restenosis of PTCA. [27][28][29][30] Given the advances, whether PTCA could replace CABG as an ideal treatment modality, remains unknown. Long term follow-up of patients is essential because the adverse outcomes of some treatments might not be obvious on a short-term follow up and the effects might also alter in the long run.…”

Construction of Hemocompatible and Histocompatible Surface by Grafting Antithrombotic Peptide ACH11 and Hydrophilic PEG

“…Cardiovascular disease is a leading cause of death throughout the world. It is often associated with thrombosis. , Implantable cardiovascular devices have emerged as attractive candidates in interventional surgery of cardiovascular disease. − However, their implantation often provokes acute thrombogenicity when they come in contact with blood . Tissue inflammation, chronic intimal hyperplasia, and subsequent in-stent restenosis are also easily induced after the cardiovascular material implantation for a period of time. , Thus, there still remains a great challenge to create an ideal cardiovascular stent with good biocompatibility.…”

Development and characterization of an ex vivo arterial long-term proliferation model for restenosis research

“…The mechanisms leading to DES restenosis are the development of neoatherosclerosis and also local inflammatory processes triggered by the anti-proliferative substance, the polymer, or the stent struts themselves (Byrne et al, 2009;Pfisterer et al, 2006). Currently available DES elute mainly mTor inhibitors (sirolimus, everolimus, biolimus or zotarolimus) and less paclitaxel, with or without a polymeric carrier (Sanchez et al, 2015;Sheth and Giugliano, 2014). The anti-proliferative effects are obtained at the cost of a significantly prolonged period of endothelialization of the stent struts and thus a dual anti platelet therapy (DAPT) of at least 6 months is indicated for DES whereas a 4-week DAPT is regarded sufficient after BMS implantation for prevention of stent thrombosis (Kolh et al, 2014).…”