Innovations in Stent Design

Stent technology continues to evolve at a rapid pace. Second-generation DESs have alleviated the safety concerns of late stent thrombosis by addressing issues of polymer biocompatibility and stent design, and optimizing drug loads and release kinetics.

Two articles in this month’s Journal of Invasive Cardiology highlight recent innovations in second-generation stent design. In the first, Dr Saami Yazdani and colleagues present a preclinical study of rabbit iliac arteries that evaluated the pharmacokinetic and vascular healing of a second-generation everolimus-eluting stent (EES) versus a new slow-release zotarolimus-eluting stent (R-ZES).

A head-to-head comparison of the second-generation EES and R-ZES groups using the healthy and atherosclerotic rabbit ilio-femoral artery model was conducted. This comparison showed equivalency in terms of neointimal growth between arteries implanted with the two stents. However, endothelialization rates differed between the two stents since greater endothelial cell maturation was observed in EES vs R-ZES implanted arteries, even though strut coverage was similar. Furthermore, significantly less inflammation was observed in the EES vs R-ZES groups, which parallels the endothelial maturation findings at 28 days.

from Yazdani

Saami K. Yazdani, PhD, Alexander Sheehy, Masataka Nakano, MD, Gaku Nakazawa, MD, Marc Vorpahl, MD, Fumiyuki Otsuka, MD, PhD, Rosy S. Donn, Laura E. Perkins, DVM, PhD, Charles A. Simonton, MD, Frank D. Kolodgie, PhD, Renu Virmani, MD Preclinical Evaluation of Second-Generation Everolimus- and Zotarolimus-Eluting Coronary Stents    J INVASIVE CARDIOL 2013;25(8):383-390

In the second article, Dr Eulogio Garcia and colleagues present the 2-year findings of the international REWAC registry. This international study focused on a new P-5 biopolymer stent (Active and Active Small), which is based on a copolymer of an acrylic derivative of triflusal, and had not been fully evaluated in routine clinical practice. The authors concluded that the implantation of paclitaxel-eluting stents coated with P-5 is associated with favorable clinical outcomes in both the short and long term (2 years) in patients with coronary artery disease.

Eulogio García, MD, Antoni Serra, MD, José Javier Zueco, MD, Mariano Larman, MD, José Ramón Rumoroso, MD, José Moreu, MD, Jordi Guarinos, MD, María Rosario Ortas, MD, Basaganyas Puigfel, MD, Adolfo Rincón, MD, Karagounis Ioannidis, MD, Núria Piqué, PhD  Long-Term Clinical Performance of Paclitaxel-Eluting Stents Coated With a Bioactive Polymer (P-5) Containing a Triflusal Derivative: Results of the REWAC Registry  J INVASIVE CARDIOL 2013;25(8):391-396

garciaFB

A selection of related articles is below:

Sang-Yup Lim, MD, Hyun-Woong Park, MD, Woo-Young Chung, MD, Song-Yee Kim, MD, Ki-Seok Kim, MD, Jang-Whan Bae, MD, Tae-Jin Youn, MD; the PROMETHEUS Study Investigators The Efficacy and Safety of PRO-Kinetic Metal Alloy Stent in Hospitalized Patients with Acute ST-Elevation Myocardial Infarction (The PROMETHEUS Study)  J Invasive Cardiol. 2012 Jun;24(6):270-3.

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Guilherme F. Attizzani, MD,  Hiram G. Bezerra, MD, PhD,  Daniel Chamié, MD, Yusuke Fujino, MD, Anna-Maria Spognardi, James R.L. Stanley, MS, DVM,  Hirosada Yamamoto, MD,  Emile Mehanna, MD, Wei Wang, MS,  Wenda C. Carlyle, PhD,  James B. McClain, PhD,  Marco A. Costa, MD, PhD     Serial Evaluation of Vascular Response After Implantation of a New Sirolimus-Eluting Stent with Bioabsorbable Polymer (MISTENT): An Optical Coherence Tomography and Histopathological Study   J INVASIVE CARDIOL 2012;24(11):560-568

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Dingcheng Xiang, MD, Shaodong Yi, MD, Yunjun Ruan, MD, Zhihua Gong, MD, Changjiang Hong, MD, Jian Qiu, MD   Comparison of Angiographic and IVUS Follow-up Between the Two Different Drug-Eluting Stents Implanted Simultaneously in the Same Individuals    J INVASIVE CARDIOL 2012;24(8):374-378

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Gianfranco Butera, MD, PhD, Davide Marini, MD, Mario Carminati, MD    In-Stent Restenosis and Aneurysm Development After Bare Stent Implantation: Rescue by e-PTFE-Covered Cheatham-Platinum Stent   J INVASIVE CARDIOL 2010;22:E209–E212

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