Angioplasty and Future Stent Types

Coronary artery disease is a major cause of death worldwide, and its incidence is rising with the passage of time. Manifestations of coronary artery disease range from mild chest discomfort that is referred to as angina, to the more severe form termed myocardial infarction; which reflects an irreversible damage to the myocardial tissue due to compromised perfusion. Risk factors associated with the development of coronary artery disease include old age, male sex, smoking, hypertension, hyperlipidemias, diabetes, obesity, stress, inactive lifestyle and a positive family history. Endothelial damage to the coronary arteries results in accumulation of fatty deposits and cellular wastes at the site of damage – a process termed atherosclerosis. The plaques thus formed render the blood vessels vulnerable to occlusion by the accumulation of platelets, if an injury occurs at the site of a plaque. The procedure termed angioplasty assists in removing this occlusion. During the procedure, a small balloon is inflated within the lumen of the narrowed blood vessel, thereby widening the vessel and allowing improved blood flow through it. Following this, a stent is inserted to maintain the patency of blood vessel. The stents are tubular in form, made of metal mesh and their purpose is to support the walls of arteries. However, various complications may arise due to the permanent presence of stents in blood vessels. Such complications can possibly delay the healing process and in some cases may result in additional plaque buildup. Formation of blood clots within the lumen of stents may cause a re-narrowing of the blood vessel. Similarly, re-stenosis due to excessive tissue growth at the site of treatment is a possible concern. To minimize this complication, drug-eluting stents that function to reduce scar tissue growth are employed. Despite this, nearly 10% of patients develop re-stenosis and the associated complications. Recently however, researchers have managed to develop dissolvable temporary stents which serve the purpose of maintaining patency of blood vessels till the time of healing. These biodegradable polylactide stents may support the artery for a period of 2 to 3 years; an interval that is sufficient to achieve optimum healing. Once healing is achieved, dissolvable stents dissolve within the bloodstream without leaving a trace of their existence; thereby preventing the development of complications like stent thrombosis, ischemic myocardial insults and lesion revascularization that may arise otherwise. Clinical trials are already underway to ascertain the effectiveness, benefits and safety of using dissolvable stents. Once approved for regular use, dissolvable stents are expected to revolutionize the outcomes of diseases that relate to arterial stenosis. With a more enhanced safety profile and minimal occurrence of thrombotic and other complications, dissolvable stents are expected to become the treatment of choice for coronary artery disease in near future.


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