New-Generation Coronary Stents: Current Data and Future Directions

Abstract

Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.

The Newest Generation of Drug-eluting Stents and Beyond

“…22 Biodegradable polymers have a lower risk of late thrombosis than first-generation DES but not compared to the new generation of durable polymer DES. 23 Whether stents with biodegradable polymers require shorter double antiplatelet therapy (DAPT) than stents with durable polymers has yet to be properly assessed in randomised studies. 24…”

Phenotypic switching prevention and proliferation/migration inhibition of vascular smooth muscle cells by the ruthenium nitrosyl complextrans-[Ru(NO)Cl(cyclam](PF6)2

“…However, according to several studies in humans and animal models, the efficacy and safety of these devices are limited, in part due to the local toxicity of the drug, antiproliferative effect on endothelial cells, delayed healing and persistent inflammatory stimuli, contributing to late intimal growth and thrombosis, besides the need for prolonged antiplatelet therapy or revascularization procedures . Subsequent stent types with newer structures, polymers and different drugs with improved release kinetics have emerged to improve both efficacy and safety . Therefore, despite great advances in the field of vascular biology and pharmacology, currently it remains significant problems with insufficient effective therapeutic strategies and associated with patient morbidity …”

“…Subsequent stent types with newer structures, polymers and different drugs with improved release kinetics have emerged to improve both efficacy and safety . Therefore, despite great advances in the field of vascular biology and pharmacology, currently it remains significant problems with insufficient effective therapeutic strategies and associated with patient morbidity …”

“…[4][5][6][7][8] Subsequent stent types with newer structures, polymers and different drugs with improved release kinetics have emerged to improve both efficacy and safety. [9,10] Therefore, despite great advances in the field of vascular biology and pharmacology, currently it remains significant problems with insufficient effective therapeutic strategies and associated with patient morbidity. [9][10][11] Under physiological conditions, VSMC residents in internal elastic lamina, the outermost part of tunica intima, express several differentiation markers, such as high levels of myofilaments, reflecting their contractile phenotype, and with proliferation index and secretory activity extremely low.…”

“…[9,10] Therefore, despite great advances in the field of vascular biology and pharmacology, currently it remains significant problems with insufficient effective therapeutic strategies and associated with patient morbidity. [9][10][11] Under physiological conditions, VSMC residents in internal elastic lamina, the outermost part of tunica intima, express several differentiation markers, such as high levels of myofilaments, reflecting their contractile phenotype, and with proliferation index and secretory activity extremely low. [2] However, conditions like vascular damage or endothelial dysfunction promote an extensive release of inflammatory cytokines and growth factors that triggers the VSMC phenotype transition and promote pathological vascular wall remodelling, which includes VSMC growth/migration, extracellular matrix over production, IH and luminal narrowing, resulting in stenosis, occlusions and frequent episodes of thrombosis.…”