Drug-eluting coronary stents:
stents and stent-ability |
Stents are endoprosthetic scaffolding devices designed
to enlarge the vessel lumen, seal dissections and create
a rounder, smoother channel. Their advent has
significantly advanced the field of interventional
cardiology. Yet, metallic stents are associated with
intima proliferation, causing in-stent restenosis and
subsequent need for reintervention in a substantial
number of patients. Considerable efforts have gone
into the development of stents covered by an active
coating designed to inhibit in-stent restenosis—the
drug-eluting stent (DES). They proved to be highly
efficacious in reducing reintervention rates, but by
inhibiting stent-driven intima hyperplasia, they also
delay vascular healing after the procedure, which
exposes treated patients to the need for prolonged
dual antiplatelet treatment and to the risk of delayed
abrupt stent closure. Moreover, the synthetic nonbioerodable
polymer containing the drug may be an important
trigger of local vascular inflammation, which
may ultimately contribute to long-term vulnerability
of the implanted stent. Second-generation DES engineered
with more biocompatible or even reabsorbable
polymers are being developed, which hopefully will
make DES equally safe as well as more efficacious
than currently available bare metal stents...
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