Drug-eluting stent restenosis: Effect of drug type, release kinetics, hemodynamics and coating strategy

Michail I. Papafaklis, Yiannis S. Chatzizisis, Katerina K. Naka, George D. Giannoglou, Lampros K. Michalis

Research output: Contribution to journalReview article

45 Scopus citations

Abstract

Restenosis following stent implantation diminishes the procedure's efficacy influencing long-term clinical outcomes. Stent-based drug delivery emerged a decade ago as an effective means of reducing neointimal hyperplasia by providing localized pharmacotherapy during the acute phase of the stent-induced injury and the ensuing pathobiological mechanisms. However, drug-eluting stent (DES) restenosis may still occur especially when stents are used in complex anatomical and clinical scenarios. A DES consists of an intravascular metallic frame and carriers which allow controlled release of active pharmaceutical agents; all these components are critical in determining drug distribution locally and thus anti-restenotic efficacy. Furthermore, dynamic flow phenomena characterizing the vascular environment, and shear stress distribution, are greatly influenced by stent implantation and play a significant role in drug deposition and bioavailability within local vascular tissue. In this review, we discuss the performance of DES and the interaction of the different DES components with the hemodynamic milieu emphasizing on the inhibition of clinical restenosis.

Original languageEnglish (US)
Pages (from-to)43-53
Number of pages11
JournalPharmacology and Therapeutics
Volume134
Issue number1
DOIs
StatePublished - Apr 1 2012

Keywords

  • Drug release
  • Drug-eluting stent
  • In-stent restenosis
  • Percutaneous coronary intervention
  • Polymer coating
  • Shear stress

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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