Cardiovascular stents: overview, evolution, and next generation

Area of Science:

• Cardiovascular medicine
• Biomaterials science
• Medical device engineering

Background:

• Drug-eluting stents (DESs) represent a significant advancement over bare-metal stents (BMSs) for treating coronary artery disease (CAD).
• Despite their benefits, concerns persist regarding in-stent restenosis (ISR) and long-term safety, linked to polymer coatings, metal platforms, and drug release kinetics.
• Adverse effects may stem from polymer degradation products and metal ion release, complicating the direct correlation between stent materials and clinical outcomes.

Purpose of the Study:

• To review recent advancements in DES design, focusing on improving clinical success and addressing limitations of current technologies.
• To explore novel strategies for optimizing DES performance, including stent composition, drug release mechanisms, and coating techniques.
• To provide a comprehensive overview of emerging DES technologies, such as biodegradable, shape-memory, and polymer-free options.

Main Methods:

• Systematic review of scientific literature on coronary stent technologies.
• Analysis of research focusing on DES design, material composition, and drug delivery systems.
• Evaluation of studies investigating factors contributing to DES failure and adverse events.

Main Results:

• DESs have shown promise but require optimization to mitigate issues like inflammation, delayed endothelialization, and stent thrombosis.
• Recent advancements focus on novel stent platforms, improved drug elution profiles, and biodegradable or polymer-free coatings.
• Understanding the interplay between stent materials, drug release, and biological response is crucial for future DES development.

Conclusions:

• Optimizing DES design is essential to overcome limitations and enhance long-term clinical efficacy and safety.
• Novel DES prototypes, including biodegradable and polymer-free options, offer potential solutions to current challenges.
• Continued research into stent-biomaterial interactions and drug release kinetics is vital for advancing cardiovascular therapies.