The coronary stent story

Abstract

The objective of this article is to narrate the story of stent development as witnessed by the author who was present from the very beginning. By the end of eighties, coronary angioplasty (PTCA) had clearly shown its limitations such as abrupt vessel occlusion, dissection and restenosis rate of up to 35%. The Medinvent Company developed a self-expanding-stent that was implanted in a first series of patients by Ulrich Sigwart in Lausanne, Switzerland in 1986. However, the multicenter study in 1989 had disastrous results, with 25% of stent occlusion rate and restenosis of >20% in remained patients. The Palmaz-Schatz stent was first bare-metal stent (BMS) largely used in the world since 1990. The heavy anticoagulation treatment was abolished by A. Colombo in 1993. By 1997, about 17 new models existed, still the abrupt stent occlusion, subacute stent thrombosis (2-4%), and restenosis (25-30%), were major problems. Drug-eluting stents (DES) were developed to specifically address the problems of restenosis encountered with BMS. The sirolimus eluting stents used since 2002 have shown better clinical results than paclitaxel eluting stents arriving in 2004, but newcomers using zotaralimus, everolimus and biolimus elusions have arrived showing even better results. Currently, the last generation of stent need only 3 months of dual antiplatelet treatment, bioapsorbale coating 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 indication benefited most from the stent development. Bioresorbable vascular scaffolds (BVS) are intended to overcome most drawbacks of stents: the presence of a metallic cage, positive remodelling, and normal vasomotor vessel function, but long-term results are still unknown.