Critical evaluation of stents in coronary angioplasty: a systematic review
Abstract Background Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BioMedical Engineering OnLine |
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| Online Access: | https://doi.org/10.1186/s12938-021-00883-7 |
| _version_ | 1818734422681190400 |
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| author | Joseph Robert Stevens Ava Zamani James Ian Atkins Osborne Reza Zamani Mohammad Akrami |
| author_facet | Joseph Robert Stevens Ava Zamani James Ian Atkins Osborne Reza Zamani Mohammad Akrami |
| author_sort | Joseph Robert Stevens |
| collection | DOAJ |
| description | Abstract Background Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current coronary stent models, their structural properties and their modes of application, with a focus on their associated risks of IST and ISR. The primary aim of this review is to identify the best stent design features for reducing the risk of IST and ISR. To review the three major types of stents used in clinical settings today, determining best and relevant clinical practice by exploring which types and features of offer improved patient outcomes regarding coronary angioplasty. This information can potentially be used to increase the success rate of coronary angioplasty and stent technology in the future taking into account costs and benefits. Methods Scientific databases were searched to find studies concerning stents. After the exclusion criteria were applied, 19 of the 3192 searched literature were included in this review. Studies investigating three major types of stent design were found: bare-metal stents (BMS), drug-eluting stents (DES) and bioresorbable stents (BRS). The number of participants varied between 14 and 1264. On average 77.4% were male, with a mean age of 64 years. Results From the findings of these studies, it is clear that DES are superior in reducing the risk of ISR when compared to BMS. Conflicting results do not clarify whether BRS are superior to DES at reducing IST occurrence, although studies into newer BRS technologies show reducing events of IST to 0, creating a promising future for BRS showing them to be non-inferior. Thinner stents were shown to reduce IST rates, due to better re-endothelialisation. Scaffold material has also been shown to play a role with cobalt alloy stents reducing the risk of IST. This study found that thinner stents that release drugs were better at preventing re-blockages. Some dissolvable stents might be better at stopping blood clots blocking the arteries when compared to metal stents. The method and procedure of implanting the stent during coronary angioplasty influences success rate of these stents, meaning stent design is not the only significant factor to consider. Conclusions Positive developments in coronary angioplasty could be made by designing new stents that encompass all the most desirable properties of existing stent technology. Further work is needed to investigate the benefits of BRS in reducing the risk of IST compared to DES, as well as to investigate the effects of different scaffold materials on IST and ISR outcomes. |
| first_indexed | 2024-12-18T00:05:07Z |
| format | Article |
| id | doaj.art-2a9b2866bf47449687a26d1275f4c1d1 |
| institution | Directory Open Access Journal |
| issn | 1475-925X |
| language | English |
| last_indexed | 2024-12-18T00:05:07Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BioMedical Engineering OnLine |
| spelling | doaj.art-2a9b2866bf47449687a26d1275f4c1d12022-12-21T21:27:50ZengBMCBioMedical Engineering OnLine1475-925X2021-05-0120112110.1186/s12938-021-00883-7Critical evaluation of stents in coronary angioplasty: a systematic reviewJoseph Robert Stevens0Ava Zamani1James Ian Atkins Osborne2Reza Zamani3Mohammad Akrami4Medical School, College of Medicine and HealthMedical School, University College London (UCL)Medical School, College of Medicine and HealthMedical School, College of Medicine and HealthDepartment of Mechanical Engineering, College of Engineering, Mathematics, and Physical Sciences, University of ExeterAbstract Background Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current coronary stent models, their structural properties and their modes of application, with a focus on their associated risks of IST and ISR. The primary aim of this review is to identify the best stent design features for reducing the risk of IST and ISR. To review the three major types of stents used in clinical settings today, determining best and relevant clinical practice by exploring which types and features of offer improved patient outcomes regarding coronary angioplasty. This information can potentially be used to increase the success rate of coronary angioplasty and stent technology in the future taking into account costs and benefits. Methods Scientific databases were searched to find studies concerning stents. After the exclusion criteria were applied, 19 of the 3192 searched literature were included in this review. Studies investigating three major types of stent design were found: bare-metal stents (BMS), drug-eluting stents (DES) and bioresorbable stents (BRS). The number of participants varied between 14 and 1264. On average 77.4% were male, with a mean age of 64 years. Results From the findings of these studies, it is clear that DES are superior in reducing the risk of ISR when compared to BMS. Conflicting results do not clarify whether BRS are superior to DES at reducing IST occurrence, although studies into newer BRS technologies show reducing events of IST to 0, creating a promising future for BRS showing them to be non-inferior. Thinner stents were shown to reduce IST rates, due to better re-endothelialisation. Scaffold material has also been shown to play a role with cobalt alloy stents reducing the risk of IST. This study found that thinner stents that release drugs were better at preventing re-blockages. Some dissolvable stents might be better at stopping blood clots blocking the arteries when compared to metal stents. The method and procedure of implanting the stent during coronary angioplasty influences success rate of these stents, meaning stent design is not the only significant factor to consider. Conclusions Positive developments in coronary angioplasty could be made by designing new stents that encompass all the most desirable properties of existing stent technology. Further work is needed to investigate the benefits of BRS in reducing the risk of IST compared to DES, as well as to investigate the effects of different scaffold materials on IST and ISR outcomes.https://doi.org/10.1186/s12938-021-00883-7CoronaryStentAngioplastyPercutaneousInterventionRevascularisation |
| spellingShingle | Joseph Robert Stevens Ava Zamani James Ian Atkins Osborne Reza Zamani Mohammad Akrami Critical evaluation of stents in coronary angioplasty: a systematic review BioMedical Engineering OnLine Coronary Stent Angioplasty Percutaneous Intervention Revascularisation |
| title | Critical evaluation of stents in coronary angioplasty: a systematic review |
| title_full | Critical evaluation of stents in coronary angioplasty: a systematic review |
| title_fullStr | Critical evaluation of stents in coronary angioplasty: a systematic review |
| title_full_unstemmed | Critical evaluation of stents in coronary angioplasty: a systematic review |
| title_short | Critical evaluation of stents in coronary angioplasty: a systematic review |
| title_sort | critical evaluation of stents in coronary angioplasty a systematic review |
| topic | Coronary Stent Angioplasty Percutaneous Intervention Revascularisation |
| url | https://doi.org/10.1186/s12938-021-00883-7 |
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