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Review
. 2023 May 2;119(3):631-646.
doi: 10.1093/cvr/cvac105.

Evolution of drug-eluting coronary stents: a back-and-forth journey from the bench to bedside

Johny Nicolas  1 , Carlo Andrea Pivato  1   2   3 , Mauro Chiarito  1   2   3 , Frans Beerkens  1 , Davide Cao  1   4 , Roxana Mehran  1
Affiliations
Review

Evolution of drug-eluting coronary stents: a back-and-forth journey from the bench to bedside

Johny Nicolas et al. Cardiovasc Res. .

Abstract

Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents (BMSs) effectively prevented abrupt vessel closure but were limited by in-stent restenosis (ISR) due to smooth muscle cell proliferation and neointimal hyperplasia. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over BMSs as it mitigated the risk of ISR. Nonetheless, they had several design limitations that increased the risk of late stent thrombosis. Significant advances in stent design, including thinner struts, enhanced polymers' formulation, and more potent antiproliferative agents, have led to the introduction of new-generation DES with a superior safety profile. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. We conclude by discussing the clinical implications of stent design in high-risk subsets of patients.

Keywords: Coronary artery disease; Drug-eluting stents; In-stent restenosis; Ischaemic heart disease; Percutaneous coronary intervention; Stent thrombosis.

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Conflict of interest statement

Conflict of interest: R.M. reports institutional research payments from Abbott, Abiomed, Alleviant Medical, AM-Pharma, Applied Therapeutics, Arena, AstraZeneca, BAIM, Bayer, Beth Israel Deaconess, Biosensors, Biotronik, Boston Scientific, Bristol-Myers Squibb, CardiaWave, CellAegis, CeloNova, CERC, Chiesi, Concept Medical, CSL Behring, Cytosorbents, DSI, Duke University, Element Science, Faraday, Humacyte, Idorsia, Insel Gruppe AG, Magenta, Medtronic, Novartis, OrbusNeich, Philips, RenalPro, Vivasure, and Zoll; personal fees from Cine-Med Research, and WebMD; consulting fees paid to the institution from Abbott, Janssen, Medtronic, Novartis; Equity <1% in Applied Therapeutics, Elixir Medical, STEL, and CONTROLRAD (spouse); Scientific Advisory Board for AMA, ACC (BOT Member), SCAI (Women in Innovations Committee Member), and JAMA Associate Editor; Faculty CRF (no fee). The other authors have nothing to disclose.