This prevents the migration of smooth muscle and allows for a thin layer of neointima to cover the struts of the stent over a period of several months. The rate of restenosis has decreased significantly , and with that, the need for repeat interventions. T he polymer usually releases the drug in weeks but then serves no other purpose. T hese polymers have the potential to produce an immune response within the artery.
This can lead to delayed healing, poor re-endothelialization , enlargement or positive remodeling of the artery, and uncovered or not completely apposed stent struts. Permanent polymers on the DES may just merely delay and not prevent resten osis.
Stents that are fully bioabsorbable have been developed and tested to provide scaffolding, or mechanical support, and deliver anti-proliferative drugs to reduce restenosis. The scaffold dissolves over a period of years and allows the artery to regain its shape and its vasoactive properties.
The Absorb bioabsorbable is quite thick micro mm and is made of bioabsorbable poly L-lactid scaffold with a bioabsorbable coating that eludes the drug everolimus.
In , we enrolled patients with stable effort angina as well as unstable angina. Three years later the patient presents again with symptoms of chest pain and cardiac catheterization revealed that the stent was still widely patent lower panel.
Intracoronary ultrasound studies of BVS treated patients demonstrated greater luminal and coronary vessel enlargement called positive remodeling. Not only could the BVS scaffold restore vasoreactivity , but it could potentially protect against developing further plaque progression and atherosclerosis.
Long term follow up studies will be needed. However , the 2 year follow-up revealed a higher rate of scaffold thrombosi s blood clot requiring further interventions, when compared to Xience stent 2. F ollowing instructions for targe t vessel selection as well as u sing longer dual antiplatelet treatment is advised. Review Process Double-blind peer review. Authorship All named authors meet the criteria of the International Committee of Medical Journal Editors for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published.
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Meta-analysis of randomized clinical trials comparing biodegradable polymer drug-eluting stent to second-generation durable polymer drug-eluting stents. We publish medical, dental, and pharmaceutical news and market insights from our analysts every day. Sign up for your free subscription here:.
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Because so much comparative research has been done on stents, he recommends studying up on past experience and knowing the geometrical structures of the devices you use inside and out. For example, in a very calcified lesion, would you be able to choose a stent with good radial strength to serve as scaffolding support for the artery itself?
Kandzari also recommends thinking about stent geometry with respect to visibility. Many of the early IVUS studies highlighted that, despite the angiographic appearance of the vessel, interventionalists often practice a concept called geographic miss, Kandzari said.
So in considering stent selection, it is important to know which device will appropriately cover the entire diseased segment of the vessel, if possible. Appropriate expansion of the stent and sizing of the stent and achieving the largest permissible minimal luminal area of the stent are important factors in achieving the best outcomes for the patient.
By definition, DES elute drugs—and you should understand each of their characteristics as well as the polymers releasing them. Specifically, Kandzari recommends knowing drug elution kinetics, safety and efficacy profiles, and how these details influence outcomes like late lumen loss, restenosis rates, and clinical events.
Most current DES designs feature durable, or biopermanent, polymers that become a lasting fixture of the stent itself, he explains. When treating complex lesions, Kandzari suggests thinking about which stent is best for specific lesion types like bifurcation lesions, chronic total occlusions, long lesions, and calcified lesions. There are certain settings in which specific stent types have been more extensively studied and therefore may be preferred. So while we may not have a definitive answer on which stent to use for every situation, pay attention to the totality of evidence.
Because of the way training programs are designed, fellows often learn to mimic the choices of their mentors, especially with regard to stent selection, Kandzari observes. But regardless of the ultimate reason for your choice, acknowledge the dynamics that influence stent selection and question yourself with every case you perform, he says.
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