Abstract
Cardiovascular disease is the greatest cause of death worldwide. Atherosclerosis is the underlying pathology responsible for two thirds of these deaths. It is the age‐dependent process of “furring of the arteries.” In many scenarios the disease is caused by poor diet, high blood pressure, and genetic risk factors, and is exacerbated by obesity, diabetes, and sedentary lifestyle. Current pharmacological anti‐atherosclerotic modalities still fail to control the disease and improvements in clinical interventions are urgently required. Blocked atherosclerotic arteries are routinely treated in hospitals with an expandable metal stent. However, stented vessels are often silently re‐blocked by developing “in‐stent restenosis,” a wound response, in which the vessel's lumen renarrows by excess proliferation of vascular smooth muscle cells, termed hyperplasia. Herein, the current stent technology and the future of biosensing devices to overcome in‐stent restenosis are reviewed. Second, with advances in nanofabrication, new sensing methods and how researchers are investigating ways to integrate biosensors within stents are highlighted. The future of implantable medical devices in the context of the emerging “Internet of Things” and how this will significantly influence future biosensor technology for future generations are also discussed.
Highlights
Atherosclerosis is the underlying pathology responsible for two thirds of implantable medical devices (IMDs) from orthopedic to cardiovascular these deaths
Subgroup analysis found that patients who presented with acute coronary syndromes, an umbrella term for MIs and unstable angina,[11] showed that bioresorbable stents (BRS) with ultrathin struts were non-inferior to the standard durable polymer (DP)-everolimus-eluting stent (EES).[38]
Target lesion failure (TLF), defined as the composite of cardiovascular death, target vessel related MI, or ischemia-driven target lesion revascularization (TLR), in the BRS was significantly improved over the DP-EES, respectively, 5.6% versus 11.0%; p = 0.023
Summary
Definite or probable stent thrombosis between the groups was significantly decreased, DES 2.0% versus BMS 4.1%; p = 0.019. This showed that an appropriate length of DAPT with DES would decrease stent thrombosis potentially improving long-term outcomes. Feinberg in a Cochrane database meta-analysis reported that DES did not significantly decrease the risks of absolute death or major adverse cardiac events (MACE) (BMS vs DES, respectively, absolute death 7.74% vs 6.97%; MACE 6.63% vs 6.36%).[19] Feinberg stated that the studies reviewed did not assess patient QOL and as such DES may not improve QOL long term in patients.[19]
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More From: Advanced science (Weinheim, Baden-Wurttemberg, Germany)
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