ReviewThe Evolution of Coronary Stents: A Brief Review
Section snippets
Neointimal formation and ISR
The mechanisms underlying ISR after PCI remain incompletely understood. Indeed, the accepted pathogenesis of ISR is in flux as numerous animal models are used to attempt to mimic and explain the mechanisms leading to restenosis. These models and their implications for therapeutic intervention have recently been reviewed.5 The most widely accepted model is an adaptation of the “response-to-injury” model proposed by Ross in 1976, whereby the mechanical disruption of the endothelial lining by PCI
First-generation DESs
Although revolutionary at the time of their development, first-generation DESs are considered rudimentary by today's standards. They are comprised of a metallic stent platform (typically stainless steel) and coated with a polymer that elutes antiproliferative and/or anti-inflammatory therapeutic agents (ie, sirolimus or paclitaxel).
Novel Approaches to Stent Development
Although current DES technology focuses on mitigating ISR formation predominately by antiproliferative mechanisms, other novel approaches are presently being studied. Based on our expanding understanding of the pathophysiology of neointimal formation and ST, elution agents with diverse mechanisms of action are being developed.
Conclusions
The advent of DESs has undoubtedly improved outcomes in patients undergoing PCI. Although first-generation DESs advanced our treatment of obstructive coronary disease, ISR and ST presented important limitations. Second-generation stents have refined the struts, polymers, and drugs eluted, thereby improving early and late outcomes (Supplemental Fig. S1). Nonetheless, as our understanding of the pathophysiology behind these processes continues to evolve, so too will our therapeutic approaches.
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These authors contributed equally to this work.