Drug-eluting Stent Technology Continues its Evolution
As technology advances, reducing thrombosis risk and increasing endothelialization will be vital.
Many of the same issues that arose with earlier treatment interventions are resurfacing with drug-eluting stent technology and outcomes.
“We’re looking for the safety we enjoyed with bare metal stents, and we want the efficacy of the drug-eluting stents,” said Peter J. Fitzgerald, MD, Professor of Medicine at Stanford University, Stanford, Calif.
“We’ve seen this before when we introduced angioplasty. We saw early on … patients with multiple lesions, we saw perforation, and there were editorials written saying we should go to medical treatment.” As more stents were used, the editorials called for a return to angioplasty.
“We are now on our third hump here, with the risk of thrombosis and people saying we should rethink this [treatment],” he said.
Key factors
The key to drug-eluting stent breakthroughs will rest with three major factors: medications, formulations and endothelial platform. Fitzgerald said he doubts that there is a “plethora of drugs to solve this problem.” Instead, the answer may lie with just the formulations and endothelial platform.
There is a delicate balance between thrombosis and endothelialization, Fitzgerald said. Several approaches are being examined to address this relationship: PC coating, which mimics the red blood cells; the polymer approach; and the next generation of interventions focusing on carrying small and large molecules and encouraging the endothelialization process.
Delicate dance
“The next generation should be able to delicately dance between endothelial coverage and function,” Fitzgerald said. This next generation of drug-eluting stents will be smaller and will be accompanied by changes in stent delivery catheters.
Another revolution in drug-eluting stents will be the fully biodegradable stents. “Ultimately, the next generation of biologic scaffolding will have to be fully biodegradable,” he said.