Bioabsorbable polymeric drugeluting endovascular stents: a clinical review

Minerva Biotecnologica, 21(4) (2009), 217-230
http://www.minervamedica.it/en/journals/minerva-biotecnologica/article.php?cod=R04Y2009N04A0217

Percutaneous transluminal balloon angioplasty followed by drug-eluting stent implantation has been of great benefit in coronary applications, whereas in peripheral applications, success rates remain low. Analysis of healing patterns in successful deployments shows that six months after implantation the artery has reorganized itself to accommodate the increase in caliber and there is no purpose for the stent to remain, potentially provoking inflammation and foreign body reaction. Late stent thrombosis due to incomplete re-endothelialization is currently the biggest concern associated with permanent drug eluting stents and strut fractures are occurring at an increasing rate. As mechanical scaffolding of the artery is not necessary once the artery has healed, a fully biodegradable polymeric stent that naturally avoids long term problems inherent to permanent stents is of great benefit. Biodegradable polymers have a widespread usage in the biomedical field, such as in sutures, scaffolds and implants. There have been major established efforts to develop biodegradable stent technology, yet so far none have been approved for commercial use. Bioabsorbable stents are on the cusp of a new era in minimally invasive intervention, which is characterized by the paradigm of dynamic implants. Stents that actively change over time – optimizing success, working in concert with the time dependent body’s reaction, and enhancing the healing process – is an ambitious goal that requires extensive cooperation between clinicians, industry, and academia.