evolution of coronary stents

Published by Oxford University Press on behalf of the European Society of Cardiology. Self-expanding stents are springy and limited in diameter and reach their predetermined diameter by removing the restraints. 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. EuroIntervention., 12 (2016), pp. Electrospinning is a unique technique using an applied voltage for the liquid atomization process. Stents should be secure and flexible enough to facilitate delivery to the lesion site. 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. Expert commentary: This paper reviews the evolution from the original pioneering work to modern day practice, highlighting landmark trials that changed practice. (a) Structure of an artery; (b) presence of atheroma; (c) enlarged lumen diameter after stenting; and (d) in-stent restenosis [25]. Fischman D.L., Leon M.B., Baim D.S., Schatz R.A., Savage M.P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M., Cleman M., Heuser R., Almond D., Teirstein P.S., Fish R.D., Colombo A., Brinker J., Moses J., Shaknovich A., Hirshfeld J., Bailey S., Ellis S., Rake R., Goldberg S. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. The ideal stent should meet a broad span of technical versions. and transmitted securely. Coated stents are new generation stents coated with a thin polymer membrane for vascular therapy. There is also a combination of these two modes, which is called a type of hybrid cell that has both radial stiffness and good flexibility. Serruys, P. De Jaegere, F. Kiemeneij, BNESTENT study group. Coronary artery aneurysm is a very rare complication mostly associated with drug-eluting stents. Fan Z., Dai N., Chen L. Expandable thermal-shaped memory metal esophageal stent: experiences with a new nitinol stent in 129 patients. A drug-eluting stent has a more complex structure, in general wrapping a polymer coating containing an antiproliferative drug around the stent struts. Charles Theodore Dotter and Melvin P Judkins in 1964, presented the first angioplasty [26]. A review of material degradation modelling for the analysis and design of bioabsorbable stents. Fig. In balloon-expandable stents, the stent is placed with the delivery system in the desired location and then deployed by the expansion of an expanded balloon (Fig. A randomized controlled trial in second-generation zotarolimus-eluting resolute stents versus everolimus-eluting Xience V stents in real-world patients: The TWENTE trial. e566-e573. Subsequently, in addition to acting as permanent vascular scaffolds, stents soon evolved to become efficient local drug delivery platforms. Recent progress in percutaneous coronary intervention: evolution of the drug-eluting stents, focus on the XIENCE V drug-eluting stent. Martin D., Boyle F.J. Computational structural modelling of coronary stent deployment: a review. The rationale behind their use is to create a temporary mechanical support in the vessel in order to prevent immediate restenosis and vascular recoil, then allowing it to degrade over time, eliminating the long-term risk associated with the presence of a metallic scaffold. In this technique, the printed filament is melted at excessive temperature and sprayed through the nozzle, and placed on a rotating shaft to hold the stent together. Patterns and mechanisms of in-stent restenosis. Stent structure and design. Tesfamariam B. Bioresorbable vascular scaffolds : biodegradation, drug delivery and vascular remodeling. Clinical utility of self-expanding stents in coronary artery disease. For this reason, the braiding technique is more suitable for making more compatible memory polymer stents [91]. The review article includes important and discussed topics from the past to the present in the field of stents, and most of the purpose is to introduce these items next to each other and categorize them, directly from 117 sources given in the references. MeSH eCollection 2022 Oct. Simard T, Jung RG, Di Santo P, Harnett DT, Abdel-Razek O, Ramirez FD, Motazedian P, Parlow S, Labinaz A, Moreland R, Marbach J, Poulin A, Levi A, Majeed K, Boland P, Couture E, Sarathy K, Promislow S, Russo JJ, Chong AY, So D, Froeschl M, Dick A, Labinaz M, Le May M, Holmes DR Jr, Hibbert B. Mayo Clin Proc Innov Qual Outcomes. Bowen P.K., Shearier E.R., Zhao S., Guillory R.J., Zhao F., Goldman J., Drelich J.W. A large body of evidence has demonstrated a significant improvement in coronary stent safety and efficacy with device evolution, making second-generation DES the treatment of choice for patients requiring coronary angioplasty. [68]. Closed-cell stents are less flexible and may have incomplete complexity and expansion. Platinum-chromium, cobalt-chromium or other alloys have largely substituted stainless steel to provide sufficient strength and visibility with thinner struts. Bethesda, MD 20894, Web Policies D: Orientation of the stent (in-phase or out-of-phase) and connectors (offset peak-to-peak; mid-shaft; peak-to-peakout-of-phase; peak-to-valleyin-phase). Among the critical areas for stress are areas close to the fork, the contact point of the stent slits, the end of the plate, the curved parts of the stent, as well as the corners, and the middle of the slit. 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. The working trend of documents on the stent (Lens Scholarly Search: Stent). Careers. Mechanical properties of some materials utilized for fabricating stents. Poncin P., Millet C., Chevy J., Proft J.L. Design and geometry of these components define the mechanical performance of a stent: crowns and rings determine radial support and expansion capacity; the number of connectors is responsible for the longitudinal stability, flexibility, deliverability, side branch access and longitudinal integrity. Biodegradable metals for cardiovascular stents: from clinical concerns to recent Zn-alloys. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. As the diameter of the stent increases, its length decreases. D.J. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Alsidawi S, Effat M, Rahman S, Abdallah M, Leesar M. Cardiovasc Ther. Jang T.S., Cheon K.H., Ahn J.H., Song E.H., Kim H.E., Do Jung H. In-vitro blood and vascular compatibility of sirolimus-eluting organic/inorganic hybrid stent coatings. Effectiveness of drug-coated balloon in acute myocardial infarction: A protocol for systematic review and meta-analysis. 2015 Jan;30(1):1-11. doi: 10.1007/s12928-014-0281-5. Grogan J.A., Leen S.B., Mchugh P.E. Stoeckel D., Bonsignore C., Duda S. A survey of stent designs. Metallic stents with a thin biodegradable abluminal polymer layer (or isolated dots) may represent a safer alternative. The First Conference on New Approaches to Medical Engineering in the Field of Cardiovascular Disease, Tehran. http://dx.doi.org/10.1056/NEJM199408253310801, http://dx.doi.org/10.1056/NEJM199408253310802, http://dx.doi.org/10.1161/CIRCULATIONAHA.112.097014, http://dx.doi.org/10.1001/jama.294.10.1215, http://dx.doi.org/10.1161/CIRCINTERVENTIONS.110.959924, http://dx.doi.org/10.1016/S0140-6736(07)61444-5, http://dx.doi.org/10.1161/CIRCULATIONAHA.106.666800, http://dx.doi.org/10.1016/j.jacc.2009.03.005, http://dx.doi.org/10.1016/j.jcin.2012.12.123, http://dx.doi.org/10.1016/j.jacc.2012.01.008, http://dx.doi.org/10.1161/CIRCULATIONAHA.111.058560, http://dx.doi.org/10.1016/j.jacc.2015.04.017, http://dx.doi.org/10.1016/j.jcin.2016.01.009, http://dx.doi.org/10.1093/eurheartj/ehp480, http://dx.doi.org/10.1016/j.ahj.2011.09.005, http://dx.doi.org/10.1016/S0140-6736(08)61244-1, http://dx.doi.org/10.1161/CIRCINTERVENTIONS.114.002372, http://dx.doi.org/10.1016/S0140-6736(07)60853-8, http://dx.doi.org/10.1016/S0140-6736(15)01039-9, http://dx.doi.org/10.1016/j.jacc.2017.05.057. Several stent features are related to the material selection, such as material types, material composition, and architectural features. Why is plain balloon angioplasty not enough? Hence, new technologies for stents are constantly being discovered and supplied every day [42]. Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and re-stenosis after transluminal angioplasty. Accessibility [1] 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. Would you like email updates of new search results? 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]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Careers, Unable to load your collection due to an error. 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). The superiority of drug-eluting stents over bare-metal stents with the recorded argument in ISR rates of somewhere in the span of 60%80% [[60], [61], [62]]. official website and that any information you provide is encrypted 1207-1214. The stent designed by Dotter et al. Bnaa, J. Mannsverk, R. Wiseth, NORSTENT Investigators. Design and Analysis of a Biodegradable Polycaprolactone Flow Diverting Stent for Brain Aneurysms. For permissions, please email: journals.permissions@oup.com. Data included in article/supp. 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. 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. Transluminally-placed coilspring endarterial tube grafts. Vascular stents, Coronary artery, Design, Materials, Processing technique, Mechanism of expansion. e002372. Charpentier E., Barna A., Guillevin L., Juliard J.-M. Stone G.W., Moses J.W., Ellis S.G., Schofer J., Dawkins K.D., Morice M.C., Colombo A., Schampaert E., Grube E., Kirtane A.J., Cutlip D.E., Fahy M., Pocock S.J., Mehran R., Leon M.B. Cardiovasc Interv Ther. MeSH 3(ad)) [[89], [90], [91], [92], [93]]. Herein we review the pathophysiology of ISR, stent thrombosis, and briefly summarize the 2023 Mar 31;102(13):e33383. Following complete elution of the drug and biodegradation of the polymer, only the metallic platform remains in the coronary artery (Table 2). 7). Wei L., Chen Q., Li Z. The other authors have nothing to disclose. Percutaneous coronary intervention (PCI) remains the cornerstone in the management of patients with acute coronary syndrome and those with chronic coronary syndrome refractory to medical management. Ways to reduce these problems include increasing radial stiffness, increasing fatigue life, reducing stent strain, and proper delivery mechanism, which are described in the following parameters. Coated stents increase tissue granulation and suppress thrombosis compared to bare-metal stents (BMS) [15]. P.S. Revista Espaola de Cardiologa is an international scientific journal devoted to the publication of research articles on cardiovascular medicine. Unauthorized use of these marks is strictly prohibited. Please enable it to take advantage of the complete set of features! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It will then compare and contrast Bodaghi M., Damanpack A.R., Liao W.H. 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. G Ital Cardiol (Rome)., 17 (2016), pp. Insufficient initial gain and restenosis led to a nearly complete loss of the clinical benefit in 30% to 40% of patients in the first 6 to 9 months (Figure 1). This site needs JavaScript to work properly. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. Abrupt occlusion obliged the pioneers of coronary angioplasty to have an active surgical stand-by during these procedures. Pharmaceutical stents or drug-coated metal stents are some of the most popular types of stents today. Erne P., Schier M., Resink T.J. 11. In: StatPearls [Internet]. The .gov means its official. Compared with balloon angioplasty, bare-metal stents effectively prevented abrupt vessel Additive production is very common today. The Evolution of Coronary Stents: A Brief Review Challenges With Current Stents. With the advent of stents, the mechanical contribution to restenosis and acute recoil have been solved, making emergency bypass surgery a thing of the past. Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Jung RG, Duchez AC, Simard T, Dhaliwal S, Gillmore T, Di Santo P, Labinaz A, Ramirez FD, Rasheed A, Robichaud S, Ouimet M, Short S, Clifford C, Xiao F, Lordkipanidz M, Burger D, Gadde S, Rayner KJ, Hibbert B. JACC Basic Transl Sci. Sangiorgi G., Melzi G., Agostoni P., Cola C., Clementi F., Romitelli P., Virmani R., Colombo A. Therefore, a new strategy to eliminate polymer-mediated complications has been the development of polymer-free DES, which can theoretically avoid these long-term negative effects, decreasing the rate of ST and allowing a shorter duration of DAPT. Medical Device Materials II - Proceedings of the Materials and Processes for Medical Devices Conference 2004. 2023 Mar 16;11:1148768. doi: 10.3389/fcell.2023.1148768. They all are summarized and put together in this review article. Tabraiz Alam M.S., Ansari A.Q., Urooj S., Aldobali M. A review based on biodegradable and bioabsorbable stents for coronary artery disease. Khoo Z.X., Teoh J.E.M., Liu Y., Chua C.K., Yang S., An J., Leong K.F., Yeong W.Y. Plastic, more durable, changes can be achieved with plaque dissection, but this mechanism carries potential risks of acute vessel closure. 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. A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. In past studies, intracoronary stent restenosis was reported to be between 10% and 20% during a six-month follow-up, leading to myocardial infarction and angina, which required re-vascularization [52]. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. All rights reserved. and transmitted securely. Although many physicians subsequently made their stents, the first stent to be approved by the food and drug administration was made in 1987 [33]. DES with biodegradable polymer or without polymer. Efficacy and safety of a novel bioabsorbable polymer-coated, everolimus-eluting coronary stent: the EVOLVE II Randomized Trial. Circ Cardiovasc Interv., 8 (2015), pp. Am. 2496-2507. government site. In this review, we introduce the types of coronary stents, materials, stent processing technique, stent design, classification of stents based on the mechanism of expansion, and problems and complications of stents. No specialty in the history of medicine has seen such rapid growth and innovation as interventional cardiology, due to a combination of the compelling need for better results in the treatment of coronary artery disease (CAD), the first cause of death worldwide, and the unique personality of remarkable individuals driving progress. Inclusion in an NLM database does not imply endorsement of, or agreement with, 2023 Feb 17;13(2):240. doi: 10.3390/membranes13020240. It should be stressed that the use of BMS requires careful patient selection, with the exclusion of particular coronary anatomy (bifurcation lesions requiring a 2-stent strategy, long lesions, left main disease, or small vessel diameter < 3mm) and clinical situation (treatment of chronic total occlusion, occlusion of saphenous vein graft, ST-segment elevation MI), in which the use of BMS is considered unadvisable.28,29. Etave F., Finet G., Boivin M., Boyer J.C., Rioufol G., Thollet G. Mechanical properties of coronary stents determined by using finite element analysis. Nowadays, the use of stents has rapidly increased, and they have been introduced in various models, with different geometries and materials. WHY IS PLAIN BALLOON ANGIOPLASTY NOT ENOUGH? Stainless steel was replaced with chrome, cobalt, or other elements to retain strength [41,54]. Stent geometry design parameters can include strut length, area and shape of strut cross-section, and strut angle. Dilatation of the diseased vessel by POBA causes a mechanical injury of the vessel wall, with subsequent endothelial denudation, mechanical damage to the vascular wall with inflammatory response and fibrosis/neointimal hyperplasia, which are the main mechanisms responsible for in-stent restenosis and acute/late stent thrombosis. Coronary stents: a materials perspective. Ho M.Y., Chen C.C., Wang C.Y., Chang S.H., Hsieh M.J., Lee C.H., Wu V.C.C., Hsieh I.C. The advent of biodegradable stents that prescribe drugs represents a significant breakthrough in coronary artery disease, which represents a step towards a change in the pattern of the treatment. Coronary stents: historical development, current status and future directions. 1629-1641. 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. Gutta-percha is a natural latex produced from tropical trees native to Southeast Asia and northern Australasia. Brennan, K.J. Steps involved in self-expanding stent delivery and deployment [115]. 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. Epub 2014 Nov 4. Researchers are working on ways to improve current stent angioplasty procedures or add adjunctive therapies. The site is secure. Careers. There is no way we could have foreseen the impact of our work so many years ago. Histopathology of vascular response to drug-eluting stents: an insight from human autopsy into daily practice. During the laser cutting process, a high-power laser canvas focuses on the tubular material, the material melts, evaporates, or wears out rapidly, and then the material is blown away by high-velocity airflow [91]. WebAbstract. 2015 Dec;33(6):360-6. doi: 10.1111/1755-5922.12160. The electrospinning technique undergoes fast development in recent years. 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]]. These data were confirmed by meta-analyses and clinical registries27 and mainly referred to the Absorb BVS, which is so far the most widely used scaffold and the only one with CE mark and FDA approval. 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. doi: 10.1097/MD.0000000000033383. The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease (CAD) since the initial introduction of balloon angioplasty. Coronary stents have revolutionized the treatment of coronary artery disease. Coated stents increase tissue granulation and suppress thrombosis compared to bare-metal stents (BMS) [15,17]. 3(a) presents braided stents [91], Fig. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over BMSs as it mitigated the risk of ISR. Plain old balloon angioplasty can transiently achieve a larger luminal diameter by plaque extrusion, but elastic recoil rapidly obliterates this gain. Accessibility This problem was overcome by the observation with intravascular ultrasound that stents required high pressure for complete expansion and the introduction of dual antiplatelet therapy (DAPT) combining ticlopidine or clopidogrel with aspirin. Antonini L., Poletti G., Mandelli L., Dubini G., Pennati G., Petrini L. Comprehensive computational analysis of the crimping procedure of PLLA BVS: effects of material viscous-plastic and temperature dependent behavior. official website and that any information you provide is encrypted Everolimus-Eluting Stents in Patients With Bare-Metal and Drug-Eluting In-Stent Restenosis: Results From a Patient-Level Pooled Analysis of the RIBS IV and V Trials. Healthcare Mater. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Coronary stents have significantly improved clinical outcomes in interventional cardiology, but there are still a number of drawbacks, including an persisted risk of thrombosis due to endothelial injury and in-stent restenosis. official website and that any information you provide is encrypted An official website of the United States government. Numerical simulation of vertebral artery stenosis treated with different stents. A coronary artery stent is a small, self-expanding, metal mesh tube. Revista Espaola de Cardiologa (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals.

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