Coronary drug-eluting stents: still room for improvement?

Coronary stents are now the most widely used revascularization treatment for coronary heart disease. Their performance has been greatly enhanced through various developments in the stent platform, materials, and deployment technique. Perhaps the most significant of these developments has been the introduction of drug-eluting stents (DES), with these devices achieving dramatic reductions in restenosis, previously the Achilles heel of bare-metal stents. A great variety of newer generation DES have since been developed, but there has only been a relatively modest improvement in clinical outcomes achieved with these more recent devices. Similarly, the clinical potential of bioresorbable stents has yet to be realized. This chapter charts the key developments in drug-eluting stent technology and identifies challenges to further progress. This chapter also considers how in silico models and advanced monitoring systems may provide better understanding of existing device performance, with a view to identifying opportunities for future development.