Drug-Eluting Stents

Abstract

Endovascular revascularization strategies have advanced tremendously over the years and are now often considered first line for treatment of peripheral arterial disease. Drug-eluting stents (DESs) have been developed as one of the tools to overcome the limitations of elastic recoil and neointimal hyperplasia observed with balloon angioplasty and bare metal stents. While these stents have been extremely successful in coronary revascularization, they have not translated as effectively to the peripheral arteries which differ in their unique mechanical environments and differences in vessel and lesion composition. DESs, through their embedded pharmaceutical agent, seek to inhibit vascular smooth muscle cell (VSMC) proliferation and migration. Paclitaxel, sirolimus, and its derivatives (-limus family) achieve VSMC inhibition through unique mechanisms. Several clinical trials have been performed to evaluate the use of DES in the femoropopliteal and infrapopliteal territory and have demonstrated overall decrease in revascularization rates and improved clinical outcomes.

Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR

“…18 Till the turn of the century, several bare metal stents were developed. 17,19,20 The modern drug-eluting stents used in the present study have designs that maintain a consistent circular lumen and prevent the acute recoil that otherwise happens with a plain balloon procedure. The in-stent restenosis has also been reduced with newer designs, drugs, and delivery agents.…”

Evaluation of paclitaxel-coated balloon angioplasty for the treatment of symptomatic intracranial in-stent restenosis

“…Recently, drug-coated balloon (DCB) angioplasty, a novel interventional technique, has been recognized as an alternative treatment for ISR ( 17–19 ). Both bare and DCB angioplasties have been validated as safe and feasible in treating symptomatic in-stent restenosis (sISR) ( 18 , 20–23 ). Particularly, paclitaxel-coated balloons (PCBs) are showing promise as a primary method for treating intracranial ISR ( 24 , 25 ).…”

Fe3O4 coated stent prevent artery neointimal hyperplasia by inhibiting vascular smooth muscle cell proliferation

“…Although drug-eluting stents (DES) are frequently used worldwide to prevent intimal hyperplasia, concerns remain regarding the occurrence of ISR in the chronic stage [ 5 ]. Limitations such as permanent metallic platforms, persistent local inflammation, and restricted vasomotion are the major causes of the aggressive proliferation of VSMCs and the generation of neointimal hyperplasia after stenting [ [5] , [6] , [7] ]. To address these drawbacks, bioresorbable stents (BRS) have been designed to address the long-term risk of complications associated with DES.…”