Polymer-free drug-eluting stents

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Drug-eluting stents (DES) have revolutionized the way that advanced coronary heart disease is now treated. These devices are associated with much lower rates of restenosis than their bare metal stent counterparts. However, the presence of a polymer coating on the stent surface, which allows for incorporation and sustained release of drug into the artery, has been implicated in the occurrence of late stent thrombosis. Consequently, a great many different polymer-free DES have since been developed. Early approaches involving direct loading of the drug on to unmodified stent surfaces were largely ineffective, which was likely due to suboptimal drug delivery kinetics characterized by very rapid release. It has since been found that stent surface modification strategies at the macro, micro and nanoscale can be used to provide more sustained drug release, with some of these strategies producing clinical results that are comparable to polymer-coated DES. Emerging clinical data on the use of the Cre8, BioFreedom, and the latest Drug Filled Stent from Medtronic Inc. suggest that these particular polymer-free DES may inhibit restenosis without delaying recovery of the endothelium, which would represent a step change improvement in performance. Whilst these devices would therefore appear to be particularly beneficial in treating high bleeding risk patients, the reduction in antiplatelet therapy duration required is likely to be an appealing feature that may see them make a wider impact more generally.
LanguageEnglish
Title of host publicationFunctionalised Cardiovascular Stents
EditorsJ. Gerard Wall, Halina Podbielska, Magdalena Wawrzyńska
Place of PublicationSan Diego, CA.
Pages57-74
Number of pages18
DOIs
Publication statusPublished - 22 Sep 2017

Fingerprint

Drug-Eluting Stents
Stents
Polymers
Equipment and Supplies
Risk Reduction Behavior
Pharmaceutical Preparations
Endothelium
Coronary Disease
Thrombosis
Pharmacokinetics
Arteries
Metals
Hemorrhage
Drug delivery
Macros
Surface treatment
Recovery
Coatings
Kinetics

Keywords

  • in-stent restenosis
  • polymer-free drug-eluting stent
  • nanoporous
  • microporous
  • macroporous
  • stent thrombosis
  • dual antiplatelet therapy

Cite this

McCormick, C. (2017). Polymer-free drug-eluting stents. In J. G. Wall, H. Podbielska, & M. Wawrzyńska (Eds.), Functionalised Cardiovascular Stents (pp. 57-74). San Diego, CA.. https://doi.org/10.1016/B978-0-08-100496-8.00004-4
McCormick, C. / Polymer-free drug-eluting stents. Functionalised Cardiovascular Stents. editor / J. Gerard Wall ; Halina Podbielska ; Magdalena Wawrzyńska. San Diego, CA., 2017. pp. 57-74
@inbook{c79ad576ff5143ffaccf86c40fbf86d6,
title = "Polymer-free drug-eluting stents",
abstract = "Drug-eluting stents (DES) have revolutionized the way that advanced coronary heart disease is now treated. These devices are associated with much lower rates of restenosis than their bare metal stent counterparts. However, the presence of a polymer coating on the stent surface, which allows for incorporation and sustained release of drug into the artery, has been implicated in the occurrence of late stent thrombosis. Consequently, a great many different polymer-free DES have since been developed. Early approaches involving direct loading of the drug on to unmodified stent surfaces were largely ineffective, which was likely due to suboptimal drug delivery kinetics characterized by very rapid release. It has since been found that stent surface modification strategies at the macro, micro and nanoscale can be used to provide more sustained drug release, with some of these strategies producing clinical results that are comparable to polymer-coated DES. Emerging clinical data on the use of the Cre8, BioFreedom, and the latest Drug Filled Stent from Medtronic Inc. suggest that these particular polymer-free DES may inhibit restenosis without delaying recovery of the endothelium, which would represent a step change improvement in performance. Whilst these devices would therefore appear to be particularly beneficial in treating high bleeding risk patients, the reduction in antiplatelet therapy duration required is likely to be an appealing feature that may see them make a wider impact more generally.",
keywords = "in-stent restenosis, polymer-free drug-eluting stent, nanoporous, microporous, macroporous , stent thrombosis, dual antiplatelet therapy",
author = "C. McCormick",
year = "2017",
month = "9",
day = "22",
doi = "10.1016/B978-0-08-100496-8.00004-4",
language = "English",
isbn = "978-0-08-100496-8",
pages = "57--74",
editor = "Wall, {J. Gerard } and Podbielska, {Halina } and Wawrzyńska, {Magdalena }",
booktitle = "Functionalised Cardiovascular Stents",

}

McCormick, C 2017, Polymer-free drug-eluting stents. in JG Wall, H Podbielska & M Wawrzyńska (eds), Functionalised Cardiovascular Stents. San Diego, CA., pp. 57-74. https://doi.org/10.1016/B978-0-08-100496-8.00004-4

Polymer-free drug-eluting stents. / McCormick, C.

Functionalised Cardiovascular Stents. ed. / J. Gerard Wall; Halina Podbielska; Magdalena Wawrzyńska. San Diego, CA., 2017. p. 57-74.

Research output: Chapter in Book/Report/Conference proceedingChapter

TY - CHAP

T1 - Polymer-free drug-eluting stents

AU - McCormick, C.

PY - 2017/9/22

Y1 - 2017/9/22

N2 - Drug-eluting stents (DES) have revolutionized the way that advanced coronary heart disease is now treated. These devices are associated with much lower rates of restenosis than their bare metal stent counterparts. However, the presence of a polymer coating on the stent surface, which allows for incorporation and sustained release of drug into the artery, has been implicated in the occurrence of late stent thrombosis. Consequently, a great many different polymer-free DES have since been developed. Early approaches involving direct loading of the drug on to unmodified stent surfaces were largely ineffective, which was likely due to suboptimal drug delivery kinetics characterized by very rapid release. It has since been found that stent surface modification strategies at the macro, micro and nanoscale can be used to provide more sustained drug release, with some of these strategies producing clinical results that are comparable to polymer-coated DES. Emerging clinical data on the use of the Cre8, BioFreedom, and the latest Drug Filled Stent from Medtronic Inc. suggest that these particular polymer-free DES may inhibit restenosis without delaying recovery of the endothelium, which would represent a step change improvement in performance. Whilst these devices would therefore appear to be particularly beneficial in treating high bleeding risk patients, the reduction in antiplatelet therapy duration required is likely to be an appealing feature that may see them make a wider impact more generally.

AB - Drug-eluting stents (DES) have revolutionized the way that advanced coronary heart disease is now treated. These devices are associated with much lower rates of restenosis than their bare metal stent counterparts. However, the presence of a polymer coating on the stent surface, which allows for incorporation and sustained release of drug into the artery, has been implicated in the occurrence of late stent thrombosis. Consequently, a great many different polymer-free DES have since been developed. Early approaches involving direct loading of the drug on to unmodified stent surfaces were largely ineffective, which was likely due to suboptimal drug delivery kinetics characterized by very rapid release. It has since been found that stent surface modification strategies at the macro, micro and nanoscale can be used to provide more sustained drug release, with some of these strategies producing clinical results that are comparable to polymer-coated DES. Emerging clinical data on the use of the Cre8, BioFreedom, and the latest Drug Filled Stent from Medtronic Inc. suggest that these particular polymer-free DES may inhibit restenosis without delaying recovery of the endothelium, which would represent a step change improvement in performance. Whilst these devices would therefore appear to be particularly beneficial in treating high bleeding risk patients, the reduction in antiplatelet therapy duration required is likely to be an appealing feature that may see them make a wider impact more generally.

KW - in-stent restenosis

KW - polymer-free drug-eluting stent

KW - nanoporous

KW - microporous

KW - macroporous

KW - stent thrombosis

KW - dual antiplatelet therapy

UR - http://www.sciencedirect.com/science/article/pii/B9780081004968000044

U2 - 10.1016/B978-0-08-100496-8.00004-4

DO - 10.1016/B978-0-08-100496-8.00004-4

M3 - Chapter

SN - 978-0-08-100496-8

SP - 57

EP - 74

BT - Functionalised Cardiovascular Stents

A2 - Wall, J. Gerard

A2 - Podbielska, Halina

A2 - Wawrzyńska, Magdalena

CY - San Diego, CA.

ER -

McCormick C. Polymer-free drug-eluting stents. In Wall JG, Podbielska H, Wawrzyńska M, editors, Functionalised Cardiovascular Stents. San Diego, CA. 2017. p. 57-74 https://doi.org/10.1016/B978-0-08-100496-8.00004-4