The coronary stent story

Leo Finci, mD, mSc, PhD, FmH, FESC, FACC.

The objecive of this aricle is to narrate the story of stent development as witnessed by the author who was present from the very beginning. By the end of eighies, coronary angioplasty (PTCA) had clearly shown its limitaions such as abrupt vessel occlusion, dissecion and restenosis rate of up to 35%. The Medinvent Company developed a self-expanding-stent that was implanted in a irst series of paients by Ulrich Sigwart in Lausanne, Switzerland in 1986. However, the mulicenter study in 1989 had disastrous results, with 25% of stent occlusion rate and restenosis of >20% in remained paients. The Palmaz-Schatz stent was irst bare-metal stent (BMS) largely used in the world since 1990. The heavy anicoagulaion treatment was abolished by A. Colombo in 1993. By 1997, about 17 new models existed, sill the abrupt stent occlusion, subacute stent thrombosis (2-4%), and restenosis (25-30%), were major problems. Drug-eluing stents (DES) were developed to speciically address the problems of restenosis encountered with BMS. The sirolimus eluing stents used since 2002 have shown beter clinical results than paclitaxel eluing stents arriving in 2004, but newcomers using zotaralimus, everolimus and biolimus elusions have arrived showing even beter results. Currently, the last generaion of stent need only 3 months of dual aniplatelet treatment, bioapsorbale coaing is only on ab-luminal side of stent, struts are thin and metallic cage is laser cut hypotube. The case of chronic total coronary occlusion is discussed, as this indicaion beneited most from the stent development. Bioresorbable vascular scafolds (BVS) are intended to overcome most drawbacks of stents: the presence of a metallic cage, posiive remodelling, and normal vasomotor vessel funcion, but long-term results are sill unknown.




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