Martin D., Boyle F.J. Computational structural modelling of coronary stent deployment: a review. The idea of the bioresorbable stent is considered revolutionary according to Erne et al. Superficial features of coronary stents play an important role in inhibiting stent restenosis and also late stent thrombosis [16]. Novel Approaches for Preventing or Limiting Events in diabetic patients (Naples- Diabetes) trial: a randomized comparison of 3 drug-eluting stents in diabetic patients. HHS Vulnerability Disclosure, Help 2023 May 25. doi: 10.1007/s12265-023-10399-1. Therefore, by summarizing these studies, the strengths and weaknesses in this field and the design of stents are determined. The mechanical properties of some of the materials used to make stents are given in Table 2 [[80], [81], [82], [83], [84], [85], [86], [87], [88]]. J Am Coll Cardiol., 65 (2015), pp. Schmidt W., Lanzer P., Behrens P., Wunderlich C.B., Oner A., Ince H., Schmitz K.P., Grabow N. Direct comparison of coronary bare metal vs. drug-eluting stents: same platform, different mechanics? Stent thrombosis in randomized clinical trials of drug-eluting stents. Helena Tizn-Marcos, Apixabn y resolucin de trombo intraventricular en un paciente con IAM, Images subject to Copyright, to apply for permission to reprint, please contact, This journal subscribes to the principles and guidelines of the Committee on Publication Ethics (COPE), Iberoamerican Cardiovascular Journals Editors' Network (RCVIB), ESC National Societies Cardiovascular Journals Editors Network, Copyright 2023. 2015 Dec;33(6):360-6. doi: 10.1111/1755-5922.12160. O'Brien B., Zafar H., Ibrahim A., Zafar J., Sharif F. Coronary stent materials and coatings: a technology and performance update. 6). Two main complications can occur with coronary stents: the gradual renarrowing of the area inside the stent, known as restenosis, and the formation of clots A randomized controlled trial in second-generation zotarolimus-eluting resolute stents versus everolimus-eluting Xience V stents in real-world patients: The TWENTE trial. Effectiveness of drug-coated balloon in acute myocardial infarction: A protocol for systematic review and meta-analysis. However, stent grafts are made of fabric. Sabat M, Rber L, Heg D, Brugaletta S, Kelbaek H, Cequier A, Ostojic M, Iiguez A, Tller D, Serra A, Baumbach A, von Birgelen C, Hernandez-Antolin R, Roffi M, Mainar V, Valgimigli M, Serruys PW, Jni P, Windecker S. JACC Cardiovasc Interv. official website and that any information you provide is encrypted However, since the polymer not only acts as a drug carrier, but also modulates the controlled release of the drug over time, the development of polymer-free DES required a new technology to maintain an adequate level of antiproliferative drug over time without the polymer vehicle (Table 2). BMS, bare metal stent; BVS, bioresorbable vascular scaffolds; DES, drug-eluting stent; POBA, plain balloon angioplasty; , balanced; For permissions, please email: journals.permissions@oup.com. Today, the use of coronary artery stents has increased. Tidwell K, Harriet S, Barot V, Bauer A, Vaughan MB, Hossan MR. Bioengineering (Basel). 2022. Fig. Stent Image courtesy of the Journal of the History of Dentistry. Numerous agents affect drug elution from polymers, and how better drug release and the duration of drug elution are the most important issues in drug-eluting stent design [53]. The evolution of coronary stents Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trials. Mechanical properties of some materials utilized for fabricating stents. Clipboard, Search History, and several other advanced features are temporarily unavailable. Chen M.S., John J.M., Chew D.P., Lee D.S., Ellis S.G., Bhatt D.L. They will also prevent future treatment bans. All these strengths and weaknesses in the studies can be seen in Table 1, and each of these topics has been examined in detail below. Colombo A., Hall P., Nakamura S., Almagor Y., Maiello L., Martini G., Gaglione A., Goldberg S.L., Tobis J.M. Coronary Stent Nonoperative dilatation of coronary-artery stenosis. Stenting is an important model in the treatment of atherosclerosis, which is performed to relieve obstruction and restore blood by placing a vascular stent on the stenosis and hard part of the artery, dilating at that point. These stents were still at a significant risk of in-stent restenosis (ISR), reported in 15% to 30% of treated lesions at mid- and long-term follow-up.3. Drug-eluting stents clearly offer an advantage over BMS with regard to restenosis. 2023 Mar 16;11:1148768. doi: 10.3389/fcell.2023.1148768. Stents at 25 years: A revolution in revascularization - Healio The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2018; 121:15121518. This phenomenon can be reduced with bioabsorbable coatings. Angioplasty; bare metal stent; bio-absorbable stent; drug eluting stent. Disclaimer. A smaller reduction of the diameter is better. 2017;56(1):1-9. doi: 10.2169/internalmedicine.56.7423. Charles Theodore Dotter and Melvin P Judkins in 1964, presented the first angioplasty [26]. Brailovski V., Prokoshkin S., Gauthier M., Inaekyan K., Dubinskiy S., Petrzhik M., Filonov M. Bulk and porous metastable beta TiNbZr(Ta) alloys for biomedical applications. Nakamura T., Shimizu Y., Ito Y., Matsui T., Okumura N., Takimoto Y., Ariyasu T., Kiyotani T. A new thermal shape memory Ti-Ni alloy stent covered with silicone. Kamalesh M., Balmuri A., Boddu A. Long-term outcome after Resolute zotarolimus-eluting stent implantation in patients with ST-segment elevation acute myocardial infarction: insights from the RESOLUTE All Comers Trial and the RESOLUTE Global Clinical Trial Program. The final 5-year follow-up from the ENDEAVOR IV trial comparing a zotarolimus-eluting stent with a paclitaxel-eluting stent. Pathophysiology of in-stent restenosis and stent thrombosis. Coronary artery stenting is the treatment of choice for CAD. Abstract. Basalus, K. Tandjung. Prediction of strength and radial recoil of various stents using FE analysis. Garca-Garca HM, Vaina S, Tsuchida K, Serruys PW. HHS Vulnerability Disclosure, Help Am. Unable to load your collection due to an error, Unable to load your delegates due to an error. Now the challenge is to develop the right cocktail of drugs, platforms and coatings to entirely eliminate, not just reduce, thrombosis and restenosis. Since the identification of neointimal hyperplasia as the major determinant of ISR, the application of antiproliferative agents was the logical answer. 8600 Rockville Pike Angioplasty with a stent is a procedure to open narrowed or blocked blood vessels. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. This goal could be obtained by the topology optimization of stents considering the fluid-solid interaction in arteries, with the objective of the structural and hemodynamics characteristics. Stenting has advantages over other treatments such as no surgery, less complexity, less pain, and faster healing. Fig. The site is secure. A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. Schmidt T., Abbott J. Coronary stents: history, design, and construction. In 1986, Puel and Sigwart set another milestone in the history of PCI by independently implanting the first self-expanding coronary stent (Wallstent, Schneider AG, Bulach, Switzerland). 8600 Rockville Pike 1629-1641. Imai M., Inoue K., Kimura T. Comparative pathological findings between coronary bare-metal stent implantation and balloon angioplasty over 16 years. Since its first application in peripheral atherosclerosis in 1963 and the first coronary angioplasty in 1977, the field of interventional cardiology has evolved and expanded enormously, with percutaneous transluminal coronary angioplasty being one of the most common procedures performed in contemporary clinical practice. The site is secure. Coronary stents are currently used in more than 90% of PCI procedures [[12], [13], [14]]. 2022 Sep 21;7(10):985-997. doi: 10.1016/j.jacbts.2022.05.002. Balloon-expandable stents are mounted on a balloon in contraction mode. Epub 2014 Nov 4. Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study. Late and very late ST declined with an incidence of less than 1% at 5 years, which is lower than that of BMS but still represents a concern because of the need to continue DAPT for 1 year and beyond.17,18 The persistence of late events and the attempt to minimize the duration and intensity of the dual antiplatelet regimen have further prompted the development of third-generation devices. The recent availability of polymer-free DES in some countries has further narrowed the area where a BMS may be needed. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Accessibility Accessibility Plastic, more durable, changes can be achieved with plaque dissection, but this mechanism carries potential risks of acute vessel closure. A BRS consists of a platform made of bioresorbable material, either magnesium or poly-L-lactic acid (PLLA), coated with a polymer and an antiproliferative drug. Coronary Artery Stents Steps involved in self-expanding stent delivery and deployment [115]. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. 2023 Apr 28;13(5):753. doi: 10.3390/jpm13050753. (a) Structure of an artery; (b) presence of atheroma; (c) enlarged lumen diameter after stenting; and (d) in-stent restenosis [25]. Mahon S.M., Bertollo N., Cearbhaill E.D., Salber J., Pierucci L., Duffy P., Durig T., Bi V., Wang W. Bio-resorbable polymer stents: a review of material progress and prospects. To overcome these challenges, stents were developed in the mid-1980s and became a major evolution in the percutaneous management of CAD. Faster smooth muscle cell coverage in ultrathin-strut drug-eluting stent leads to earlier re-endothelialization. The .gov means its official. Comparing coronary stent material performance on a common geometric platform through simulated bench testing. The first stents were made from stainless steel and, despite their thick struts and poor flexibility, showed superiority over POBA, with elimination of abrupt occlusion and a reduced rate of restenosis, confirmed in 2 historic trials published in 1993 (the BENESTENT and the STRESS trials1,2). As a library, NLM provides access to scientific literature. Areas covered: The conversion from plain old balloon angioplasty (POBA) to the present era of drug eluting stents (DES) has been driven by many technological advances and large bodies of clinical trial evidence. Screw extrusion-based 3D printing system consists of three main components: x-y-z motion system, rotation axis, and mini-screw extruder. All authors listed have significantly contributed to the development and the writing of this article. Very late ST, although now recognized as a possible complication of first-generation DES, is a rare entity and numerous meta-analyses and data registries have provided reassurance about the use of such devices.12, Major Randomized Controlled Trials Comparing Bare Metal Stents With Current-generation Drug-eluting Stents. Boland E.L., Shine R., Kelly N., Sweeney C.A., McHugh P.E. Stainless steel was replaced with chrome, cobalt, or other elements to retain strength [41,54]. In the body, there is increasing pressure on temporary implants, which requires the implanted material to be predictable over time to disappear. Hytonen J.P., Taavitsainen J., Tarvainen S., Herttuala S.Y. Obiweluozor F.O., Maharjan B., Gladys Emechebe A., Park C.H., Kim C.S. WebDescription When a stent is placed into the body, the procedure is called stenting. reports institutional research payments from Abbott, Abiomed, Alleviant Medical, AM-Pharma, Applied Therapeutics, Arena, AstraZeneca, BAIM, Bayer, Beth Israel Deaconess, Biosensors, Biotronik, Boston Scientific, Bristol-Myers Squibb, CardiaWave, CellAegis, CeloNova, CERC, Chiesi, Concept Medical, CSL Behring, Cytosorbents, DSI, Duke University, Element Science, Faraday, Humacyte, Idorsia, Insel Gruppe AG, Magenta, Medtronic, Novartis, OrbusNeich, Philips, RenalPro, Vivasure, and Zoll; personal fees from Cine-Med Research, and WebMD; consulting fees paid to the institution from Abbott, Janssen, Medtronic, Novartis; Equity <1% in Applied Therapeutics, Elixir Medical, STEL, and CONTROLRAD (spouse); Scientific Advisory Board for AMA, ACC (BOT Member), SCAI (Women in Innovations Committee Member), and JAMA Associate Editor; Faculty CRF (no fee). Cassar A., Jr D.R.H., Rihal C.S., Gersh B.J., Gps N., Qbujfou F. Chronic coronary artery disease: diagnosis and management. e002372. In these clinical scenarios, the small anticipated benefit to be gained from reduced restenosis may be balanced by the need to withhold the antiplatelet regimen. Indeed, there is still a long road ahead before BRS can be routinely used in clinical practice. The current-generation of PLLA BRS showed higher rates of device thrombosis and MI at 1 year. (3) [94]: where Rdistalload is the radius of the end of the stent after pressure and Rcentralload is the radius of the center of the stent after pressure. Brancati M., Burzotta F., Trani C., Leonzi O., Cuccia C., Crea F. Coronary stents and vascular response to implantation: literature review. 1-year outcomes with the Absorb bioresorbable scaffold in patients with coronary artery disease: a patient-level, pooled meta-analysis. 3(ad)) [[89], [90], [91], [92], [93]]. In this editorial, we provide an overview of the development of coronary stents since their introduction in the late 1980s, with special focus on currently available stents and bioresorbable scaffolds. An official website of the United States government. Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients. Very long-term safety and effectiveness of drug-eluting or bare-metal stents for left main coronary disease. Subsequently, in addition to acting as permanent vascular scaffolds, stents soon evolved to become efficient local drug delivery platforms. Sirolimus and paclitaxel were the 2 antiproliferative drugs initially used in first-generation DESs (respectively CYPHER [Cordis, Milpitas, CA] and TAXUS [Boston Scientific, Marlborough, Massachusetts]). Poerner TC, Otto S, Gassdorf J, Nitsche K, Janiak F, Scheller B, Goebel B, Jung C, Figulla HR. Coronary Balloon-expandable stents attain their maximum diameter at the moment of implantation, self-expanding stents continue to expand after several days and reach their maximum diameter, just a few weeks after implantation [110]. Modern day [28]. Hoffmann R., Mintz G.S., Dussaillant G.R., Popma J.J., Pichard A.D., Satler L.F., Kent K.M., Griffin J., Leon M.B. It will then compare and contrast Saraf A.R., Yadav S.P. CRF is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. e566-e573. Stent coverage and neointimal proliferation in bare metal stents postdilated with a Paclitaxel-eluting balloon versus everolimus-eluting stents: prospective randomized study using optical coherence tomography at 6-month follow-up. Evaluation of coronary stents: A review of types, materials, Bioresorbable metals in cardiovascular stents: material insights and progress. The purpose of this article is to provide a complete overview of advanced research in the field of stents and to discuss and conclude important studies on different topics in the field of stents. In 1969, Dotter, using stainless steel to wrap the coil stent, took the lead in researching the structure of vascular stents [[27], [28], [29]], Fig. Angioplasty plus stenting. Auricchio F., Constantinescu A., Conti M., Scalet G. Fatigue of metallic stents : from clinical evidence to computational analysis. In stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario. 2023 Jun 1;107(6):1278-1285. doi: 10.1097/TP.0000000000004606. From October 1989 through June 1991, 115 patients undergoing PTCA received intracoronary stents to treat acute or threatened closure in 119 vessels. Krankenberg H., Zeller T., Ingwersen M., Schmalstieg J., Gissler H.M., Nikol S., Baumgartner I., Diehm N., Nickling E., Hulsbeck S.M., Schmiedel R., Torsello G., Hochholzer W., Stelzner C., Brechtel K., Ito W., Kickuth R., Blessing E., Thieme M., Nakonieczny J., Nolte T., Gareis R., Boden H., Sixt S. Self-expanding versus balloon-expandable stents for Iliac artery occlusive disease. Levy E.I., Mehta R., Gupta R., Hanel R.A., Chamczuk A.J., Fiorella D., Woo H.H., Albuquerque F.C., Jovin T.G., Horowitz M.B., Hopkins L.N. Despite the achievement of DESs within the decrease of the ISR rate, issues have emerged over the long-time bio-compatibility of these devices because of cases of late destructive medicinal activities including stent thrombosis [63]. These infections can lead to coronary perforations and mycotic aneurysms. In general, there are three major types of coronary stents available today that are implanted in coronary arteries through angioplasty or percutaneous coronary intervention, consisting of [[43], [44], [45], [46], [47], [48], [49], [50]]. government site. However, stents fit the open-cell formation best with angled vessels or twisted anatomy. Evolving Coronary Stent Technologies - A Glimpse Into the Future. Clinical Effectiveness of Coronary Stents in the Elderly: Results from 262,700 Medicare Patients in ACC-NCDR. Major Randomized Controlled Trials Comparing Bare Metal Stents With Current-generation Drug-eluting Stents, Table 2. Ang H.Y., Huang Y.Y., Lim S.T., Wong P., Joner M., Foin N. Mechanical behavior of polymer-based vs. metallic-based bioresorbable stents. The reduction of vessel diameter (more than 50%) after stenting is called recurrent stenosis, which will disrupt blood flow. Bioresorbable scaffolds could be either a metallic alloy (magnesium or iron alloy) or an L-isomer of PLLA polymeric platform, covered with a polymer and an antiproliferative drug. Grogan J.A., Leen S.B., Mchugh P.E. Closed-cell stents are grooved tubes that are laser-shaped and have a higher radial stiffness than the open-cell model [99] (Fig. Federal government websites often end in .gov or .mil. Prithipaul P.K.M., Kokkolaras M., Pasini D. Assessment of structural and hemodynamic performance of vascular stents modelled as periodic lattices. Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries. Herein we review the pathophysiology of ISR, stent thrombosis, and briefly summarize the doi: 10.1097/MD.0000000000033383. Cardiology Today | Throughout the history of cardiology, several milestones have marked modern medicines fascination with and research into the heart: the first 2014 Dec;7(6):760-7. doi: 10.1161/CIRCINTERVENTIONS.113.001146. Before Dotter C.T., Judkins M.P. Arch Cardiol Mex. Coated stents increase tissue granulation and suppress thrombosis compared to bare-metal stents (BMS) [15]. Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Current Second-generation Drug-eluting Stents With Durable Polymer, With Biodegradable Polymer and Without a Polymer. Provoked exercise desaturation in patients with Coronary malperfusion in acute type A aortic Use of a pediatric risk score for cardiac Multicenter, superiority for TLR; noninferiority for death, MI, stroke, ST, PES superior for TLR and noninferior for clinical endpoints, Diabetes mellitus, SA, UA, positive stress test, Angiographic in-segment restenosis at 6 mo, SA, UA, silent ischemia, positive stress test, Diabetes mellitus, SA, UA, silent ischemia, positive stress test, Death, nonfatal MI, clinically-driven TVR at 3 y, Noninferiority for SES; superiority for PES, PC-ZES noninferior to SES and superior to PES, Death, MI, any revascularization, TLR and ST, Cardiac death, reinfarction, definite or probable ST, and TVR at 3 y, Similar efficacy; SES associated with a reduction in ST, TVF, cardiac death, MI, and clinically-indicated TVR, Multicenter, noninferiority or superiority, Cardiac death, MI, definite ST, and TVR at 9 mo. Clinical utility of self-expanding stents in coronary artery disease. Are you a health professional able to prescribe or dispense drugs? Twenty-Year Evolution of Percutaneous Coronary Intervention and Alfonso F, Prez-Vizcayno MJ, Garca Del Blanco B, Garca-Touchard A, Lpez-Mnguez JR, Masotti M, Zueco J, Melgares R, Mainar V, Moreno R, Domnguez A, Sanchs J, Bethencourt A, Moreu J, Cequier A, Mart V, Otaegui I, Bastante T, Gonzalo N, Jimnez-Quevedo P, Crdenas A, Fernndez C; under the auspices of the Interventional Cardiology Working Group of the Spanish Society of Cardiology. The site is secure. Your heart doesn't just pump bloodit needs blood to survive. Federal government websites often end in .gov or .mil. WebConclusions The known pharmacokinetic elution profile of Cypher stents and the presence of polymer fragments surrounded by giant cells and eosinophils suggest that a reaction to the polymer may have caused late stent thrombosis. Sangiorgi G., Melzi G., Agostoni P., Cola C., Clementi F., Romitelli P., Virmani R., Colombo A. Metallic stents with a thin biodegradable abluminal polymer layer (or isolated dots) may represent a safer alternative. Naturally, the smaller the length of this reduction, the more desirable it is. Degradation of the bioresorbable polymer occurs simultaneously with controlled release of the antiproliferative drug in the early phase after implantation. From its humble beginnings of experimental work, PCI has transitioned over years Drug-eluting coronary stents: insights from preclinical and pathology studies. 1350-1361. Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and re-stenosis after transluminal angioplasty.
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