Biodegradable Polymers and Stents: the Next Generation?
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SECONDARY PREVENTION AND INTERVENTION (D. STEINBERG, SECTION EDITOR)
Biodegradable Polymers and Stents: the Next Generation? Guilly Rebagay 1 & Sripal Bangalore 1,2 Published online: 11 June 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review Stent design continues to evolve with newer generation of stents aimed at improving clinical outcomes. This review compares different generations of stents with a focus on biodegradable polymers and stents and their potential benefits. Recent Findings Drug-eluting stents (DES) reduce stent thrombosis when compared with bare-metal stents (BMS). However, they are associated with impaired vascular healing/endothelialization and excess very long-term events (beyond 1 year). Much of these events (beyond 1 year) have been attributed to continued inflammation due to the polymer. Biodegradable-polymer drugeluting stents (BP DES) were designed to overcome this polymer related limitation of first-generation DP DES by combining the benefits of reduced in-stent restenosis seen with DES and the benefits of reduced very-late stent thrombosis and myocardial infarction due to absence of polymer with bare-metal stents (BMS). Earlier generation of BP DES showed superiority over firstgeneration DP DES but at best non-inferior to second-generation DP DES for clinical outcomes; however, the newer-generation BP DES with ultrathin struts show promise in further reducing clinical outcomes when compared with second-generation DP DES. Whether this is due to the biodegradable polymer or the ultrathin struts continues to be debated. Summary Biodegradable polymer stents in conjunction with ultrathin struts have shown promise as the next generation of DES; however, additional studies and long-term follow-up are needed to confirm these effects. Keywords Biodegradable polymer stent . Ultrathin struts . Restenosis
Introduction As the incidence of ischemic heart disease continues to rise over the past several decades and remains the leading cause of death worldwide [1], percutaneous coronary intervention (PCI) and stent design have evolved to face this global epidemic. Through the years, from Gruentzig’s first balloon percutaneous transluminal coronary angioplasty (PTCA) to the development of contemporary coronary stents, the aim to optimally recanalize obstructive atherosclerotic plaque with the intention to not only improve symptoms of angina and quality of life (in those with stable ischemic heart disease) but also This article is part of the Topical Collection on Secondary Prevention and Intervention * Sripal Bangalore [email protected] 1
New York University School of Medicine, New York, NY, USA
2
Complex Coronary Intervention (Bellevue), Cardiac Catheterization Laboratory, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, SKI 9R/109, New York, NY 10016, USA
reduce hard clinical endpoints of myocardial infarction and death (in those presenting with acute coronar
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