Coronary artery stents (old)

Summary

Percutaneous coronary interventions were revolutionised by the introduction of coronary stents, which were designed to prevent many of the acute complications of balloon angioplasty. Despite their proven benefits in the acute setting, the initial bare metal stent devices were associated with neointimal hyperplasia due to deep arterial injury giving rise to in-stent restenosis in 20-30% of cases. The latter was one of the primary driving forces behind the development of drug-eluting stents with controlled release of anti-proliferative agents released from polymers directly immobilized on the stent surface. Early generation drug-eluting stents releasing sirolimus or paclitaxel successfully addressed the problem of restenosis by reducing the need of repeat revascularization by 50-70% compared with bare metal stents in nearly all patient and lesion subsets. However, safety concerns were raised in relation to their potential to delay arterial healing and to increase the risk of very late stent thrombosis. These concerns prompted modifications to stent design and have resulted in a wide array of newer generation drug-eluting stents which utilise novel anti-proliferative agents, modified stent platforms and polymers with improved biocompatibility and clinical outcomes. This chapter reviews the data supporting the use of current and newly developed drug-eluting coronary stents.

Introduction

The...