Vishnu Jithin, Manivasagam Geetha, Mantovani Diego, Udduttula Anjaneyulu, Coathup Melanie J, Popat Ketul C, Ren Pei-Gen, Prashanth K G
Centre for Biomaterials, Cellular and Molecular Theranostics, CBCMT, Vellore Institute of Technology, Vellore, 632014 India.
Lab. for Biomaterials and Bioengineering, Department of Mining, Metallurgical and Materials Engineering & CHU de Quebec Research Centre, Laval University, Quebec City, QC Canada.
In Vitro Model. 2022 Jan 31;1(2):151-175. doi: 10.1007/s44164-022-00009-w. eCollection 2022 Apr.
Balloon expandable coronary stenting has revolutionized the field of interventional cardiology as a potential, minimally invasive modality for treating coronary artery disease. Even though stenting is successful compared to angioplasty (that leaves no stent in place), still there are many associated clinical complications. Bare metal stents are associated with in-stent restenosis caused mostly by neointimal hyperplasia, whereas success of drug-eluting stents comes at the expense of late-stent thrombosis and neoatherosclerosis. Even though innovative and promising, clinical trials with bioabsorbable stents reported thrombosis and a rapid pace of degradation without performing scaffolding action in several instances. It should be noted that a vast majority of these stents are based on a metallic platform which still holds the potential to mitigate major cardiovascular events and reduced economic burden to patients, alongside continuous improvement in stent technology and antiplatelet regimes. Hence, a systematic review was conducted following PRISMA guidelines to assess the clinically relevant material properties for a metallic stent material. From a materials perspective, the major causes identified for clinical failure of stents are inferior mechanical properties and blood-material interaction-related complications at the stent surface. In addition to these, the stent material should possess increased radiopacity for improved visibility and lower magnetic susceptibility values for artefact reduction. Moreover, the review provides an overview of future scope of percutaneous coronary interventional strategy. Most importantly, this review highlights the need for an interdisciplinary approach by clinicians, biomaterial scientists, and interventional cardiologists to collaborate in mitigating the impediments associated with cardiovascular stents for alleviating sufferings of millions of people worldwide.
球囊扩张式冠状动脉支架置入术作为一种治疗冠状动脉疾病的潜在微创方式，彻底改变了介入心脏病学领域。尽管与血管成形术（术后不留支架）相比，支架置入术很成功，但仍存在许多相关的临床并发症。裸金属支架与主要由新生内膜增生引起的支架内再狭窄有关，而药物洗脱支架的成功是以晚期支架血栓形成和新动脉粥样硬化为代价的。尽管生物可吸收支架具有创新性且前景广阔，但多项临床试验报告称，在某些情况下，生物可吸收支架会出现血栓形成以及降解速度过快且无法起到支撑作用的情况。应当指出的是，这些支架绝大多数基于金属平台，随着支架技术和抗血小板治疗方案的不断改进，该平台仍有减轻重大心血管事件及降低患者经济负担的潜力。因此，我们按照PRISMA指南进行了一项系统评价，以评估金属支架材料的临床相关材料特性。从材料角度来看，支架临床失败的主要原因是机械性能较差以及支架表面与血液 - 材料相互作用相关的并发症。除此之外，支架材料应具有更高的射线不透性以提高可视性，并具有较低的磁化率值以减少伪影。此外，该评价还概述了经皮冠状动脉介入策略的未来发展方向。最重要的是，本评价强调临床医生、生物材料科学家和介入心脏病学家需要采取跨学科方法进行合作，以减轻与心血管支架相关的障碍，从而减轻全球数百万人的痛苦。
