Abstract
Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.
Highlights
Stenting of arteries became a common treatment of cardiovascular medicine, enabling the re-opening of the narrowed vessels and restoring the normal blood flow
The nitric oxide-generating material prepared by the method possesses the capability of scavenging free radicals and catalyzing S-nitrosothiols to produce nitrogen monoxide, which is known to reduce the risks of thrombosis, inflammation, and restenosis related to the stent applications
The results show that the films consist of anatase and rutile mixture with nanostructure and nitrogen as nitric oxide (NO) located at intergranular positions in the form of an NO two-dimensional layer located at the TiO2 grains boundary
Summary
Stenting of arteries became a common treatment of cardiovascular medicine, enabling the re-opening of the narrowed vessels and restoring the normal blood flow. Especially very promising and rapid development of drug eluting stents (DES), demonstrate good efficacy with a low rate of treatment failure, making it possible to expand the stent application to patients with complicated diseases [1]. The first generation of stents, BMS, usually fabricated from stainless steel (316L), cobalt–chromium (Co–Cr) and platinum–iridium (Pt–Ir) alloys, tantalum (Ta), or nitinol (Ni–Ti) have shown numerous problems leading to tissue hyperplasia, in-stent restenosis and the necessity to explant them or to keep them as a foreign body during the whole life These considerations pushed the development of coated stents, DES, and biodegradable stents (BDS) [3]. In the forthcoming sections, the authors discuss the correlation of such events with the stent surface properties, highlighting the benefits of using different kinds of stents
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