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Published on: October 26, 2016
The evolution of coronary stents: a brief review
Trevor Simard1, Benjamin Hibbert1, F Daniel Ramirez1
1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Drug-eluting stents (DESs) improve percutaneous coronary intervention outcomes but face challenges like in-stent restenosis and stent thrombosis. This review covers DES pathophysiology, clinical evidence, and future therapeutic strategies.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Percutaneous coronary intervention (PCI) is a primary revascularization method.
- Early PCI with balloon angioplasty had high restenosis rates due to dissections, recoil, and neointimal growth.
- Coronary stents improved outcomes, but in-stent restenosis (ISR) remains a challenge in 20-30% of cases.
Purpose of the Study:
- To review the pathophysiology of ISR and stent thrombosis.
- To summarize clinical evidence for first- and second-generation drug-eluting stents (DESs).
- To discuss advancements in ISR pathogenesis and novel therapeutic strategies.
Main Methods:
- Literature review of ISR and stent thrombosis.
- Summary of clinical trial data for DESs.
- Discussion of current research on DES performance and future directions.
Main Results:
- DESs reduce neointimal formation but present challenges like delayed re-endothelialization and stent thrombosis.
- First- and second-generation DESs have shown incremental improvements in PCI outcomes.
- Understanding ISR pathogenesis is advancing, paving the way for new treatments.
Conclusions:
- DESs represent a significant advancement in PCI, yet challenges persist.
- Further research into ISR and stent thrombosis is crucial for improving long-term patient outcomes.
- Novel therapeutic strategies are being explored to enhance DES efficacy and safety.
Abstract:
Percutaneous coronary intervention is the most prevalent method for coronary artery revascularization. Initial interventions using balloon angioplasty had limited efficacy because coronary dissections, arterial recoil, and neointimal formation led to high rates of abrupt vessel closure and clinical restenosis. With the introduction of coronary stents, vascular dissections were stabilized and arterial recoil was eliminated, but neointimal accumulation remained problematic, resulting in the development of in-stent restenosis (ISR) in 20%-30% of cases. Drug-eluting stents (DESs) were developed to release antiproliferative agents at the site of arterial injury to attenuate neointimal formation. Although DESs have incrementally improved outcomes after percutaneous coronary intervention, delayed re-endothelialization and stent thrombosis remain important challenges. Herein we review the pathophysiology of ISR, stent thrombosis, and briefly summarize the clinical evidence behind first- and second-generation DESs. Moreover, we discuss advancements in our understanding of the pathogenesis of ISR and potential novel therapeutic strategies to improve clinical outcomes.
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