Modern Stents: Where Are We Going? - PubMed (original) (raw)

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Modern Stents: Where Are We Going?

Ofer Kobo et al. Rambam Maimonides Med J. 2020.

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.

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Conflict of interest statement

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Figures

Figure 1

Figure 1. Stent Structures

Several examples of the different geometrical stent structures in the early years of stents. Adapted from Figure 3 of Paisal et al. [

CC by 3.0

].

Figure 2

Figure 2. Different DES Designs

Design characteristics (cross-sectional cut) of representative drug-eluting stents and bioabsorbable scaffold/stents. The characteristics of past and current commercial drug-eluting stents including durable polymer (DP)-, biodegradable polymer (BP)-, and polymer free-DES. Types of materials (alloy, drug, and polymer), strut thickness, and estimated duration of polymer absorption (in BP-DES) for each stent are described. CoCr, cobalt chromium; Ir, iridium; Mo, months; PBMA, poly(butyl methacrylate); PC, phosphorylcholine-coated; PCL, poly-ɛ-caprolactone; PDLA, poly-d-lactic acid; PDLGA, poly(d,l-lactide-co-glycolide); PDLLA, poly-d,l-lactic acid; PEVA, poly (ethylene-vinyl acetate); PGA, polyglycolic acid; PLGA, poly(lactide-co-glycolide); PLLA, poly-l-lactic acid; Pt, platinum; SS, stainless steel.

Figure 3

Figure 3. Evolution of Coronary Stents

BMS, bare metal stent; BVS, bioresorbable vascular scaffolds; DES, drug-eluting stent; POBA, plain balloon angioplasty; ↔, balanced; ↑, increased; ↓, decreased; ↓↓, greatly decreased.

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