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Development of In Vitro Endothelialised Stents - Review
Jitsuro Tsukada1,2, P Mela3, M Jinzaki4
1Department of Diagnostic Radiology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan. tsukada.jitsuro@nihon-u.ac.jp.
Insights
Tissue engineering offers promising solutions for improving stent biocompatibility. In vitro endothelialization methods show potential for reducing stent thrombosis and restenosis, addressing limitations of current drug-eluting stents (DES).
Area of Science:
- Biomaterials Science
- Cardiovascular Research
- Tissue Engineering
Background:
- Drug-eluting stents (DES) reduce restenosis but stent thrombosis remains a clinical challenge.
- Late stent complications, including thrombus formation, lead to severe outcomes like acute coronary syndromes and limb ischemia.
- Current DES technologies do not fully address the need to prevent late stent complications.
Purpose of the Study:
- To review tissue-engineered stents developed using in vitro endothelialization techniques.
- To focus on fabrication processes, cell selection, stent materials, and surface modifications.
- To evaluate the efficacy and safety of these engineered stents based on existing studies.
Main Methods:
- Review of in vitro endothelialization approaches for stent development.
- Analysis of cell source selection, stent material composition, and surface modification strategies.
- Examination of in vitro and in vivo study data on efficacy and safety.
Main Results:
- In vivo endothelialized stents have shown limited clinical efficacy.
- In vitro endothelialization allows for pre-implantation quality control of cell type and growth.
- Tissue-engineered stents using in vitro methods are being explored as alternatives to overcome DES limitations.
Conclusions:
- In vitro endothelialization presents a viable strategy for developing improved stent technologies.
- Further research into tissue-engineered stents is crucial for addressing late stent thrombosis and restenosis.
- These advancements hold potential for better patient outcomes in cardiovascular and peripheral arterial disease treatment.
Abstract:
Endovascular treatment is prevalent as a primary treatment for coronary and peripheral arterial diseases. Although the introduction of drug-eluting stents (DES) dramatically reduced the risk of in-stent restenosis, stent thrombosis persists as an issue. Notwithstanding improvements in newer generation DES, they are yet to address the urgent clinical need to abolish the late stent complications that result from in-stent restenosis and are associated with late thrombus formation. These often lead to acute coronary syndromes with high mortality in coronary artery disease and acute limb ischemia with a high risk of limb amputation in peripheral arterial disease. Recently, a significant amount of research has focused on alternative solutions to improve stent biocompatibility by using tissue engineering. There are two types of tissue engineering endothelialisation methods: in vitro and in vivo. To date, commercially available in vivo endothelialised stents have failed to demonstrate antithrombotic or anti-stenosis efficacy in clinical trials. In contrast, the in vitro endothelialisation methods exhibit the advantage of monitoring cell type and growth prior to implantation, enabling better quality control. The present review discusses tissue-engineered candidate stents constructed by distinct in vitro endothelialisation approaches, with a particular focus on fabrication processes, including cell source selection, stent material composition, stent surface modifications, efficacy and safety evidence from in vitro and in vivo studies, and future directions.
