Modern Stents: Where Are We Going?

Abstract

Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. We describe the major advancements with this technology. There have been significant developments in the design of stents and adjunctive medical therapies. Newer-generation drug-eluting stents (DES) have almost negligible restenosis rates and, when combined with proper anti-platelet treatment and optimal deployment, a low risk of stent thrombosis. The introduction of newer-generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new antiproliferative agents has further improved the safety profile of early-generation DES. In parallel the effectiveness has been kept, with a significant reduction in the risk of target lesion revascularization compared with the early-generation DES. However, to date, the development of completely bioresorbable vascular scaffolds has failed to achieve further clinical benefits and has been associated with increased thrombosis. Newer-generation DES-including both durable polymer as well as biodegradable polymer-have become the standard of care in all patient and lesion subsets, with excellent long-term results.

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

“…[ 6 ]. Efforts were made to change all three components (platform, coating, and drug) of previous-generation stents [ 49 ]. Other materials were proposed for the metallic platform, namely cobalt-chromium and platinum-chromium alloys, as they allowed a reduction in the strut thickness [ 6 ].…”

“…Such devices are called drug-filled stents (DFSs) and provide controlled elution from an internal stent lumen, avoiding the inflammation associated with polymers from earlier generations of DESs [ 168 , 169 ]. Early trials were considered successful as DFSs presented promising results, such as minimal neointimal hyperplasia and a high degree of stent strut coverage at one month after implantation in optical coherence tomography [ 49 , 170 ].…”

“…Drug-coated balloons are particularly attractive in treating de novo lesions, especially in small-vessel disease. This method has shown similar results in treating restenosis as implanting a second DES layer, but the much higher price limits its use [ 49 , 171 , 172 , 173 ].…”

“…The structure of the first generation of DESs was based on a stainless-steel platform coated with a drug-eluting durable polymer [6,23,45] (Figure 3). Such devices allow localized elution over the course of a month of neointimal inhibiting drugs, such as sirolimus and paclitaxel, which have antiproliferative effects [46][47][48][49]. DESs were mainly adopted as a solution for in-stent restenosis, a major problem associated with the stenting procedure [52].…”

Targeting the epigenome in in-stent restenosis: from mechanisms to therapy

“…Zotarolimus is an analog of rapamycin. Sirolimus and its analog could inhibit the proliferation and migration of VSMCs by blocking the cell cycle from the G 1 to S phase 21 , 22 through suppressing rapamycin mammalian targets. These drugs reduce the proliferation of VSMCs but harm the endothelialization of scaffold strut support.…”