Abstract
Cardiovascular diseases have been the leading cause of death in modern society. Using vascular stents to treat these coronary and peripheral artery diseases has been one of the most effective and rapidly adopted medical interventions. During the twenty-five years’ development of vascular stents, revolutionary cardiovascular stents like drug eluting stents and endothelial progenitor cells capture stents have emerged. In this review, the evolution of vascular stents is summarized, aiming to provide a glimpse into the future of vascular stents. Advanced designs, focusing on the investigations of new substrates, new platforms, new drugs and new biomolecules are currently under evaluation with promising clinical studies. The concept of “time sequence functional stent” has been raised in this paper. It presents anti-proliferative properties in the first phase after implantation and subsequently support endothelialization. It also shows long-term inertness without release of toxic ions or toxic degradation products. The success of this concept is briefly presented with a clinical study in this model stents.
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Mackman N. Triggers, targets and treatments for thrombosis. Nature, 2008, 451: 914–918
World Health Organization. World Health Statistics, 2012
Fontaine B, Fresno C. Vascular Stent. United States Patent, US005314472A, 1994-5-24
Alfonso F. Treatment of drug-eluting stent restenosis the new pilgrimage: Quo vadis? J Am Coll Cardiol, 2010, 55: 2717–2720
Ong A T, McFadden E P, Regar E, et al. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol, 2005, 45: 2088–2092
Daemen J, Serruys P W. Drug-eluting stent update 2007: Part I. A survey of current and future generation drug-eluting stents: Meaningful advances or more of the same? Circulation, 2007, 116: 316–328
Grüntzig A, Schneider H J. The percutaneous dilatation of chronic coronary stenoses-experiments and morphology. Schweiz Med Wochenschr, 1977, 107: 1588
Sigwart U, Puel J, Mirkovitch V, et al. Intravascular stents to prevent occlusion and re-stenosis after transluminal angioplasty. N Engl J Med, 1987, 316: 701–706
O’Brien B, Carroll W. The evolution of cardiovascular stent materials and surfaces in response to clinical drivers: A review. Acta Biomater, 2009, 5: 945–958
Mani G, Feldman M D, Patel D, et al. Coronary stents: A materials perspective. Biomaterials, 2007, 28: 1689–1710
Farb A, Weber D K, Kolodgie F D, et al. Morphological predictors of restenosis after coronary stenting in humans. Circulation, 2002, 105: 2974–2980
Inoue T, Croce K, Morooka T, et al. Vascular inflammation and repair implications for re-endothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv, 2011, 4: 1057–1066
Welt F G P, Rogers C. Inflammation and restenosis in the stent era. Arterioscler Thromb Vasc Biol, 2002, 22: 1769–1776
Newby A C, Zaltsman A B. Molecular mechanisms in intimal hyperplasia. J Pathol, 2000, 190: 300–309
Albiero R, Nishida T, Adamian M. et al. Edge restenosis after implantation of high activity 32P radioactive β-emitting stents. Circulation, 2000, 101: 2454–2457
Leon M B, Teirstein P S, Moses J W, et al. Localized intracoronary gamma-radiation therapy to inhibit the recurrence of restenosis after stenting. N Engl J Med, 2001, 344: 250–256
Stone G W, Ellis S G, Cox D A, et al. One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent the TAXUS-IV trial. Circulation, 2004, 109: 1942–1947
Tung R, Kaul S, Diamond G A, et al. Narrative review: Drug-eluting stents for the management of restenosis: A critical appraisal of the evidence. Ann Intern Med, 2006, 144: 913–919
Kay I P, Wardeh A J, Kozuma K, et al. Radioactive stents delay but do not prevent in-stent neointimal hyperplasia. Circulation, 2001, 103: 14–17
Martin D M, Boyle F J. Drug-eluting stents for coronary artery disease: A review. Med Eng Phys, 2011, 33: 148–163
Wolf K V, Zong Z, Meng J, et al. An investigation of adhesion in drug-eluting stent layers. J Biomed Mater Res A, 2008, 87: 272–281
Ranade S V, Miller K M, Richard R E, et al. Physical characterization of controlled release of paclitaxel from the TAXUS™ Express2™ drug-eluting stent. J Biomed Mater Res A, 71A: 625–634
Windecker S, Remondino A, Eberli F R, et al. Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med, 2005, 353: 653–662
Morice M C, Colombo A, Meier B, et al. Sirolimus-vs paclitaxel-eluting stents in de novo coronary artery lesions: The REALITY trial: A randomized controlled trial. JAMA, 2006, 295: 895–904
Guagliumi G, Farb A, Musumeci G, et al. Sirolimus eluting stent implanted in human coronary artery for 16 months: Pathological findings. Circulation, 2003, 107: 1340–1341
Virmani R, Guagliumi G, Farb A, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent should we be cautious? Circulation, 2004, 109: 701–705
Pendyala L K, Yin X H, Li J S, et al. The first-generation drug-eluting stents and coronary endothelial dysfunction. JACC-Cardiovasc Interv, 2009, 2: 1169–1177
McFadden E P, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet, 2004, 364: 1519–1521
Khan W, Farah S, Domb A J. Drug eluting stents: Developments and current status. J Control Release, 2012, 161: 703–712
Burke S E, Kuntz R E, Schwartz L B. Zotarolimus (ABT-578) eluting stents. Adv Drug Deliv Rev, 2006, 58: 437–446
Sheiban I, Villata G, Bollati M, et al. Next-generation drug-eluting stents in coronary artery disease: Focus on everolimus-eluting stent (Xience V®). Vasc Health Risk Manag, 2008, 4: 31–38
Lange R A, Hillis L D, Stone G W, et al. Second-generation drug-eluting coronary stents. N Engl J Med, 2010, 362: 1728–1730
Wykrzykowska J J, Onuma Y, Serruys P W. Advances in stent drug delivery: The future is in bioabsorbable stents. Expert Opin Drug Deliv, 2009, 6: 113–126
Kukreja N, Onuma Y, Daemen J, et al. The future of drug-eluting stents. Pharmacol Res, 2008, 57: 171–180
Waksman R. Drug-eluting stents from bench to bed. Cardiovasc Radiat Med, 2002, 3: 226–241
Wessely R. New drug-eluting stent concepts. Nat Rev Cardiol, 2010, 7: 194–203
Schwartz R S, Edelman E R, Carter A, et al. Drug-eluting stents in preclinical studies recommended evaluation from a consensus group. Circulation, 2002, 106: 1867–1873
Garg S, Swrruys P W. Coronary stents looking forward. J Am Coll Cardiol, 2010, 56(Suppl 10): S43–S78
Nakazawa G, Finn A V, Kolodgie F D, et al. A review of current devices and a look at new technology: Drug-eluting stents. Expert Rev Med Devices, 2009, 6: 33–42
Grube E, Buellesfeld L. BioMatrix® Biolimus A9®-eluting coronary stent: A next-generation drug-eluting stent for coronary artery disease. Expert Rev Med Devices, 2006, 3: 731–741
Abizaid A, Costa J R. New drug-eluting stents an overview on biodegradable and polymer-free next-generation stent systems. Circ Cardiovasc Interv, 2010, 3: 384–393
Tsujino I, Ako J, Honda Y, et al. Drug delivery via nano-, micro and macroporous coronary stent surfaces. Expert Opin Drug Deliv, 2007, 4: 287–295
Ohlow M A, von Korn H, Farah A, et al. TCT-601 real-world experience of the polymer-free rapamycin-eluting YUKON-Choice stent: Five-year results from a prospective registry. J Am Coll Cardiol, 2012, 60(Suppl 17): B174
Joner M, Finn A V, Farb A, et al. Pathology of drug eluting stents in humans: Delayed healing and late thrombotic risk. J Am Coll Cardiol, 2006, 48: 193–202
Ormiston J A, Serruys P W S. Bioabsorbable coronary stents. Circ Cardiovasc Interv, 2009, 2: 255–260
Bourantas C V, Onuma Y, Farooq V, et al. Bioresorbable scaffolds: Current knowledge, potentialities and limitations experienced during their first clinical applications. Int J Cardiol, 2012, 167: 11–21
Nair L S, Laurencin C T. Biodegradable polymers as biomaterials. Prog Polym Sci, 2007, 32: 762–798
Moravej M, Mantovani D. Biodegradable metals for cardiovascular stent application. Int J Mol Sci, 2011, 12: 4250–4270
Tamai H, Igaki K, Takafumi T, et al. A biodegradable poly-L-lactic acid coronary stent in the porcine coronary. J Interv Cardiol, 1999, 12: 443–450
Tamai H, Igaki K, Kyo E, et al. Initial and 6-month results of biodegradable poly-L-lactic acid coronary stents in humans. Circulation, 2000, 102: 399–404
Nishio S, Kosuga K, Igaki K, et al. long-term (>10 years) clinical outcomes of first-in-human biodegradable poly-l-lactic acid coronary stents: Igaki-tamai stents. Circulation, 2012, 125: 2343–2353
Raoul B, Asgar W A. Biodegradable stents-Where are we in 2009? US cardiol, 2009, 6: 81–84
Serruys P W, Ormiston J A. Onuma Y, et al. A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-Year outcomes and results from multiple imaging methods. Lancet, 2009, 373: 897–910
Onuma Y, Serruys P W. Bioresorbable scaffold: The advent of a new era in percutaneous coronary and peripheral revascularization? Circulation, 2011, 123: 779–797
Hermawan H, Dubé D, Mantovani D. Developments in metallic biodegradable stents. Acta Biomater, 2010, 6: 1693–1697
Yun Y, Dong Z Y, Lee N, et al. Revolutionizing biodegradable metals. Mater Today, 2009, 12: 22–32
Zberg B, Uggowitzer P J, Loeffler J F. MgZnCa glasses without clinically observable hydrogen evolution for biodegradable implants. Nat Mater, 2009, 8: 887–891
Gu X N, Zheng Y F, Cheng Y, et al. In vitro corrosion and biocompatibility of binary magnesium alloys. Biomaterials, 2009, 30: 484–498
Erbel R, Di Mario C, Bartunek J, et al. Temporary scaffolding of coronary arteries with bioabsorbable magnesium stents: A prospective, non-randomised multicentre trial. Lancet, 2007, 369: 1869–1875
Bosiers M. AMS insight-Absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-Month analysis. Cardiovasc Interv Radiol, 2009, 32: 424–435
Waksman R, Pakala R. Biodegradable and bioabsorbable stents. Curr Pharm Design, 2010, 16: 4041–4051
Haude M, Erbel R, Erne P, et al. Safety and performance of the drug-eluting absorbable metal scaffold (DREAMS) in patients with de-novo coronary lesions: 12 Month results of the prospective, multicentre, first-in-man BIOSOLVE-I trial. Lancet, 2013, 381: 836–844
Zhu S F, Huang N, Xu L, et al. Biocompatibility of pure iron: In vitro assessment of degradation kinetics and cytotoxicity on endothelial cells. Mat Sci Eng C, 2009, 29: 1589–1592
Schaffer J E, Nauman E A, Stanciu L A. Cold-drawn bioabsorbable ferrous and ferrous composite wires: An evaluation of in vitro vascular cytocompatibility. Acta Biomater, 2012, doi: 10.1016/j.actbio.2012.07.043
Mueller P P, May T, Perz A, et al. Control of smooth muscle cell proliferation by ferrous iron. Biomaterials, 2006, 27: 2193–2200
Purnama A, Hermawan H, Champetier S, et al. Gene expression profile of mouse fibroblasts exposed to a biodegradable iron alloy for stents. Acta Biomater, 2013, doi: 10.1016/j.actbio.2013.02.033
Peuster M, Wohlsein P, Brugmann M, et al. A novel approach to temporary stenting: Degradable cardiovascular stents produced from corrodible metal-results 6–18 months after implantation into New Zealand white rabbits. Heart, 2001, 86: 563–569
Waksman R O N, Pakala R, Baffour R, et al. Short-term effects of biocorrodible iron stents in porcine coronary arteries. J Interv Cardiol, 2008, 21: 15–20
Liu B, Zheng Y F. Effects of alloying elements (Mn, Co, Al, W, Sn, B, C and S) on biodegradability and in vitro biocompatibility of pure iron. Acta Biomater, 2011, 7: 1407–1420
Hermawan H, Purnama A, Dube D, et al. Fe-Mn alloys for metallic biodegradable stents: Degradation and cell viability studies. Acta Biomater, 2010, 6: 1852–1860
Schinhammer M, Hänzi A C, Löffler J F, et al. Design strategy for biodegradable Fe-based alloys for medical applications. Acta Biomater, 2010, 6: 1705–1713
Bowen P K, Drelich J, Goldman J. Zinc exhibits ideal physiological corrosion behavior for bioabsorbable stents. Adv Mater, 2013, 25: 2577–2582
Asahara T, Murohara T, Sullivan A, et al. Isolation of putative progenitor endothelial cells for angiogenesis. Science, 1997, 275: 964–967
Yoder M C. Defining human endothelial progenitor cells. J Thromb Haemost, 2009, 7(Suppl 1): 49–52
Avci-Adali M, Ziemer G, Wendel H P. Induction of EPC homing on biofunctionalized vascular grafts for rapid in vivo self-endothelialization-A review of current strategies. Biotechnol Adv, 2010, 28: 119–129
Wendel H P, Avci-Adali M, Ziemer G. Endothelial progenitor cell capture stents-Hype or hope? Int J Cardiol, 2010, 145: 115–117
Padfield G J, Newby D E, Mills N L. Understanding the role of endothelial progenitor cells in percutaneous coronary intervention. J Am Coll Cardiol, 2010, 55: 1553–1565
Klomp M, Beijk M A M, de Winter R J. GenousTM endothelial progenitor cell-capturing stent system: A novel stent technology. Expert Rev Med Devices, 2009, 6: 365–375
Yeh E T, Zhang S, Wu H D, et al. Transdifferentiation of human peripheral blood CD34+-enriched cell population into cardiomyocytes, endothelial cells, and smooth muscle cells in vivo. Circulation, 2003, 108: 2070–2073
Granada J F, Inami S, Aboodi M S, et al. Development of a novel prohealing stent designed to deliver sirolimus from a biodegradable abluminal matrix. Circ Cardiovasc Interv, 2010, 3: 257–266
OrbusNeich’s Combo Dual Therapy StentTM Demonstrates Favorable Clinical and Safety Outcomes at 12-Month Follow-Up. OrbusNeich Report, 2012
Lee S W L, Lam S C C, Chan K K W, et al. TCT-292 evaluation of neointimal healing and late luminal loss of endothelial progenitor cell capturing sirolimus-eluting (COMBO) stent by optical coherence tomography: The EGO-COMBO dtudy. J Am Coll Cardiol, 2012, 60(Suppl 17): B82
Lee J M, Choe W S, Kim B K, et al. Comparison of endothelialization and neointimal formation with stents coated with antibodies against CD34 and vascular endothelial-cadherin. Biomaterials, 2012, 33: 8917–8927
Sim D S, Kim Y S, Hong Y J, et al. Original paper: Experience with endothelial progenitor cell capturing aptamers for coating of intracoronary stents in a porcine model. Tissue Eng Regener Med, 2009, 6: 555–561
Veleva A N, Heath D E, Cooper S L, et al. Selective endothelial cell attachment to peptide-modified terpolymers. Biomaterials, 2008, 29: 3656–3661
Li Q Y, Tang G H, Xue S H, et al. Silica-coated superparamagnetic iron oxide nanoparticles targeting of EPCs in ischemic brain injury. Biomaterials, 2013, 34: 4982–4992
Avci-Adali M, Stoll H, Wilhelm N, et al. In vivo tissue engineering: Mimicry of homing factors for self-endothelialization of blood-contacting materials. Pathobiology, 2013, 80: 176–181
Park S, Bhang S H, La W G, et al. Dual roles of hyaluronic acids in multilayer films capturing nanocarriers for drug-eluting coatings. Biomaterials, 2012, 33: 5468–5477
Yang J, Zeng Y, Zhang C, et al. The prevention of restenosis in vivo with a VEGF gene and paclitaxel co-eluting stent. Biomaterials, 2013, 34: 1635–1643
Qi P K, Maitz M F, Huang N. Surface modification of cardiovascular materials and implants. Surf Coat Technol, 2013, doi: http://dx.doi.org/10.1016/j.surfcoat.2013.02.008
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Qi, P., Yang, Y., Maitz, F.M. et al. Current status of research and application in vascular stents. Chin. Sci. Bull. 58, 4362–4370 (2013). https://doi.org/10.1007/s11434-013-6070-1
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DOI: https://doi.org/10.1007/s11434-013-6070-1