Drug-eluting coronary stents: insights from preclinical and pathology studies.,Nature Reviews Cardiology

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Drug-eluting coronary stents: insights from preclinical and pathology studies.
Nature Reviews Cardiology ( IF 41.7 ) Pub Date : 2019-07-25 , DOI: 10.1038/s41569-019-0234-x
Sho Torii ₁ , Hiroyuki Jinnouchi ₁ , Atsushi Sakamoto ₁ , Matthew Kutyna ₁ , Anne Cornelissen ₁ , Salome Kuntz ₁ , Liang Guo ₁ , Hiroyoshi Mori ₁ , Emanuel Harari ₁ , Ka Hyun Paek ₁ , Raquel Fernandez ₁ , Diljon Chahal ₂ , Maria E Romero ₁ , Frank D Kolodgie ₁ , Anuj Gupta ₂ , Renu Virmani ₁ , Aloke V Finn _{1,

2}

Affiliation

Implantation of drug-eluting stents (DES) is the dominant treatment strategy for patients with symptomatic coronary artery disease. However, the first-generation DES had substantial drawbacks, including delayed healing, local hypersensitivity reactions and neoatherosclerosis, which all led to a steady increase in major adverse cardiovascular events over time. Subsequently, newer-generation DES were introduced with thinner struts, different scaffold designs (to improve deliverability while maintaining radial strength), different durable and biodegradable polymers - and in some cases no polymer (to improve vascular biocompatibility) - and new antiproliferative drug types and doses. Currently, >30 different DES are commercially available in Europe, with fewer available in the USA but with many new entrants coming onto the US market in the next few years. Never before have cardiologists been faced with so many choices of stent, each with its own unique design. In this Review, we detail preclinical and pathology studies for each stent design, examining thromboresistance, speed of neointimal coverage and completeness of healing, including endothelialization. We conclude by discussing how these design characteristics might affect the potential for shortening the minimum duration of dual antiplatelet therapy needed after coronary intervention.

中文翻译：

药物洗脱冠状动脉支架：来自临床前和病理学研究的见解。

植入药物洗脱支架（DES）是有症状的冠状动脉疾病患者的主要治疗策略。然而，第一代 DES 有很大的缺点，包括延迟愈合、局部超敏反应和新动脉粥样硬化，随着时间的推移，这些都导致主要不良心血管事件的稳定增加。随后，新一代 DES 引入了更薄的支柱、不同的支架设计（以提高输送能力同时保持径向强度）、不同的耐用和可生物降解聚合物 - 在某些情况下没有聚合物（以提高血管生物相容性） - 以及新的抗增殖药物类型和剂量。目前，欧洲有超过 30 种不同的 DES，在美国的供应量较少，但未来几年将有许多新进入者进入美国市场。心脏病专家以前从未面临过如此多的支架选择，每种支架都有自己独特的设计。在这篇综述中，我们详细介绍了每种支架设计的临床前和病理学研究，检查了抗血栓性、新内膜覆盖的速度和愈合的完整性，包括内皮化。我们最后讨论了这些设计特征如何影响缩短冠状动脉介入治疗后所需的双联抗血小板治疗的最短持续时间的潜力。新内膜覆盖的速度和愈合的完整性，包括内皮化。我们最后讨论了这些设计特征如何影响缩短冠状动脉介入治疗后所需的双联抗血小板治疗的最短持续时间的潜力。新内膜覆盖的速度和愈合的完整性，包括内皮化。我们最后讨论了这些设计特征如何影响缩短冠状动脉介入治疗后所需的双联抗血小板治疗的最短持续时间的潜力。

更新日期：2019-07-25

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