Clinical Impact of Stent Design

Abstract

The introduction and widespread adoption of drug-eluting stents into routine clinical practice has seen tremendous changes in the practice of interventional cardiology. For a prolonged period, manufacturers have focused research on drugs and polymers that are the key to the prevention of in-stent restenosis. However, stent platform design and its clinical implications have now come back to the fore. This has occurred for numerous reasons, but has primarily been driven by the need for modern stents to perform well in increasingly demanding clinical scenarios. This paper reviews the historical evolution of stent platform design. Current manufacturing processes and materials are also explored. Geometric stent construction and its implications for longitudinal stability and the longer term risks of stent fracture are reviewed. Finally, the implications of the specific stent chosen for different clinical applications including the treatment of bifurcations and left main disease are also summarised. This article will familiarise cardiologists with the crucial impact of each of these factors on modern day practice, as well as acute and long-term outcomes for patients.

Keywords: Stent design; left main stem stenting; longitudinal compression; stent fracture; stent thrombosis.

Figure 1:. Examples of Some Drug-eluting and Bare Metal Stents

Figure 2:. Optical Coherence Tomography Images of a Well-deployed Bioresorbable Vascular Scaffold (A) and the Same Stent After Longitudinal Deformation Caused by a Guide Catheter (B)