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Coronary and Endovascular Stents, An Issue of Interventional Cardiology Clinics, E-Book

Coronary and Endovascular Stents, An Issue of Interventional Cardiology Clinics, E-Book

Sahil A. Parikh

(2016)

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Book Details

Abstract

This issue of the Interventional Cardiology Clinics, edited by Dr. Sahil Parikh, is entitled "Coronary and Endovascular Stents" and covers a wide array of topics. Subjects covered include, but are not limited to, a historical review of stent development; the rationale for stenting; principles of stent design; the role of stent composition and surface modification; endovascular drug delivery and drug elution systems; design and clinical considerations for BRS and endovascular stent grafts; the pathology of endovascular stents, and stent failures.


Table of Contents

Section Title Page Action Price
Front Cover Cover
INTERVENTIONAL CARDIOLOGY CLINICS i
Copyright ii
CONTRIBUTORS iii
EDITOR-IN-CHIEF iii
EDITOR iii
AUTHORS iii
CONTENTS v
Preface: Stent Design: Past, Present, and Future\r v
The History of Coronary Stenting\r v
Restenosis of the Coronary Arteries: Past, Present, Future Directions\r v
The Systems Biocompatibility of Coronary Stenting\r v
Endovascular Drug Delivery and Drug Elution Systems: First Principles\r vi
Antiproliferative Drugs for Restenosis Prevention\r vi
Contemporary Drug-Eluting Stent Platforms: Design, Safety, and Clinical Efficacy\r vi
Design Principles of Bioresorbable Polymeric Scaffolds\r vi
Bioresorbable Scaffolds: Clinical Outcomes and Considerations\r vii
Design and Comparison of Large Vessel Stents: Balloon Expandable and Self-Expanding Peripheral Arterial Stents365 vii
Design and Clinical Considerations for Endovascular Stent Grafts\r vii
Pathology of Endovascular Stents\r vii
Coronary Stent Failure: Fracture, Compression, Recoil, and Prolapse\r viii
CORONARY AND ENDOVASCULAR STENTS ix
FORTHCOMING ISSUES ix
RECENT ISSUES ix
PREFACE: Stent Design: Past, Present, and Future\r xi
The History of Coronary Stenting 271
KEY POINTS 271
INTRODUCTION 271
REFERENCES 279
Restenosis of the Coronary Arteries 281
KEY POINTS 281
BACKGROUND 281
Definition and Incidence 281
MECHANISMS OF RESTENOSIS 282
Normal Versus Pathologic Response to Arterial Injury 282
Endothelial Injury, Platelet Activation, Inflammation 282
Smooth Muscle Cell Migration, Proliferation, and Extracellular Matrix Formation 282
CLINICAL FEATURES OF RESTENOSIS 284
Predictors of Restenosis 284
Patterns of Restenosis 285
Time Course of Restenosis 286
PREVENTING RESTENOSIS: STENT EVOLUTION AND DESIGN 286
Drug Elution 286
Polymer and Elution Kinetics 286
Scaffold Redesign 287
TREATMENT OF RESTENOSIS 288
After Percutaneous Transluminal Coronary Angioplasty 288
After Bare-Metal Stent 288
After Drug-Eluting Stent 288
Debulking and Other Plaque-Modifying Modalities 288
SUMMARY AND FUTURE DIRECTIONS 289
REFERENCES 289
The Systems Biocompatibility of Coronary Stenting 295
KEY POINTS 295
INTRODUCTION 295
BARE METALS AND PASSIVE MATERIALS 296
Passive Coatings 296
Microscale and Macroscale Features 297
ACTIVE DRUG-ELUTING SURFACES 299
Durable Coatings 299
Polymer-Free and Bioresorbable Coatings 301
SYSTEMS BIOCOMPATIBILITY AND FULL BIORESORBTION IN THE TREND OF LOW-PROFILE DEVICES 301
ACKNOWLEDGMENTS 303
REFERENCES 303
Endovascular Drug Delivery and Drug Elution Systems 307
KEY POINTS 307
INTRODUCTION 307
TISSUE PHARMACOKINETICS CAN LIMIT DRUG EFFICACY 307
MECHANISMS CONTROLLING LOCAL DRUG RELEASE 310
DEVICE-BASED ENDOVASCULAR DRUG DELIVERY STRATEGIES 310
Durable Adherent Coatings 310
Biodegradable Adherent Coatings 313
Deployable Coatings 313
Polymer-free Coated Stents 317
Drug-filled Stents 318
SUMMARY/DISCUSSION 319
REFERENCES 319
Antiproliferative Drugs for Restenosis Prevention 321
KEY POINTS 321
INTRODUCTION 321
MOLECULAR MECHANISM OF MAMMALIAN TARGET OF RAPAMYCIN INHIBITORS 322
MAMMALIAN TARGET OF RAPAMYCIN INHIBITORS: SIROLIMUS AND ITS ANALOGUES 323
NEOATHEROSCLEROSIS 325
PACLITAXEL 325
NOVEL ANTI-RESTENOSIS AGENTS 327
SUMMARY 327
REFERENCES 327
Contemporary Drug-Eluting Stent Platforms 331
KEY POINTS 331
INTRODUCTION 331
COMPONENT DESIGN 332
Metallic Stent Scaffold 332
Stent Polymer Coating 333
Released Antiproliferative Drug 334
COMMERCIALLY AVAILABLE, CONTEMPORARY, FIRST-GENERATION DRUG-ELUTING STENT PLATFORMS 334
DEVICE-RELATED SAFETY OUTCOMES: INSIGHTS FROM MECHANICAL AND DEVICE INTEGRITY AND FAILURE 336
Stent Fracture 336
Longitudinal Deformation 336
Pathologic Correlates of Stent Fracture 337
Patient-Related Safety Outcomes: Insights from Clinical Experience 337
CLINICAL EFFICACY OF SPECIFIC STENT PLATFORMS 337
Paclitaxel-Eluting Stents 337
Zotarolimus-Eluting Stents 338
Everolimus-Eluting Stents 339
CLINICAL SAFETY AND EFFICACY IN SELECTED PATIENT POPULATIONS 342
Acute Myocardial Infarction 342
Chronic Kidney Disease 343
Diabetes Mellitus 343
SUMMARY 343
REFERENCES 343
Design Principles of Bioresorbable Polymeric Scaffolds 349
KEY POINTS 349
INTRODUCTION 349
Mechanisms for Polymeric Degradation 350
PRINCIPLES OF OPERATION 350
Revascularization 350
Restoration 351
Resorption 352
SUMMARY 353
REFERENCES 354
Bioresorbable Scaffolds 357
KEY POINTS 357
INTRODUCTION 357
CLINICAL DEVELOPMENT OF CURRENT-GENERATION BIORESORBABLE SCAFFOLDS 358
Absorb 358
DESolve 360
ART 360
Fortitude 360
NeoVas 360
Mirage 361
MeRes 361
Xinsorb 361
Fantom 361
DREAMS 361
QUO VADIS, BIORESORBABLE SCAFFOLD? 361
SUMMARY 362
REFERENCES 362
Design and Comparison of Large Vessel Stents 365
KEY POINTS 365
BACKGROUND 365
STENT DESIGN: PHYSICAL PROPERTIES 366
STENT DESIGN: THREE-DIMENSIONAL PROPERTIES 366
STENT DESIGN: HEMODYNAMICS AND FLOW MODIFICATION 367
STENT DESIGN: ALLOYS AND CORROSION 370
STENT DESIGN: ASSOCIATED MATERIALS 371
STENT DESIGN: COATINGS 371
STENT DESIGN: RADIO-OPACITY 371
STENT DESIGN: FABRICATION 371
STENT DESIGN: GEOMETRY 372
Individual Rings 372
Sequential Rings 372
Woven 373
Helical 373
Coil 373
STENT DESIGN: STRUT THICKNESS 373
STENT DESIGN: NUMBER OF STRUTS 373
STENT DESIGN: FLEXIBILITY, TRACKING, AND CONFORMABILITY 373
STENT DESIGN: RADIAL AND LONGITUDINAL STRENGTH 374
STENT DESIGN: DRUGS AND DELIVERY 374
Bare Metal Versus Drug-eluting Peripheral Stents 375
STENT DEPLOYMENT 375
Balloon-Expandable 375
Self-Expanding 376
Vascular Mimetic 377
The Perfect Stent 378
SUMMARY 378
REFERENCES 378
Design and Clinical Considerations for Endovascular Stent Grafts 381
KEY POINTS 381
INTRODUCTION 381
THE FIRST ENDOVASCULAR AORTIC ANEURYSM REPAIRS 382
OVERVIEW OF ENDOVASCULAR AORTIC ANEURYSM REPAIR TECHNIQUE 382
DESIGN PRINCIPLES OF ENDOVASCULAR STENT GRAFTS 382
CLINICAL AND ANATOMIC CONSIDERATIONS/LIMITATIONS 383
CURRENT ENDOVASCULAR STENT GRAFTS COMMERCIALLY AVAILABLE (IN THE UNITED STATES) 383
MODERN ADVANCES: PARALLEL STENTS, FENESTRATED ENDOVASCULAR ANEURYSM REPAIR, AND OTHER NEW DEVICES 383
TROUBLESHOOTING/COMPLICATIONS 387
SUMMARY 388
REFERENCES 388
Pathology of Endovascular Stents 391
KEY POINTS 391
INTRODUCTION 391
NATIVE CORONARY ARTERY DISEASE 391
PATHOLOGY OF BALLOON ANGIOPLASTY 392
PATHOLOGY OF BARE METAL STENTS 392
PATHOLOGY OF DRUG-ELUTING STENTS: IN-STENT RESTENOSIS 393
NEOATHEROSCLEROSIS 394
PATHOLOGY OF DRUG-ELUTING STENTS: LATE IN-STENT THROMBOSIS 396
SECOND-GENERATION DRUG-ELUTING STENTS 397
NEXT-GENERATION STENTS AND SCAFFOLDS 397
SUMMARY 398
ACKNOWLEDGMENTS 398
REFERENCES 398
Coronary Stent Failure 405
KEY POINTS 405
INTRODUCTION 405
CORONARY STENT FRACTURE 405
Mechanisms of Coronary Stent Fracture 405
Classification of Coronary Stent Fractures 406
Clinical Implications of Coronary Stent Fracture 406
Treatment of Coronary Stent Fracture 407
Summary 407
LONGITUDINAL STENT DEFORMATION 407
Mechanisms and Classification of Longitudinal Stent Deformation 408
Clinical Impact and Treatment of Longitudinal Stent Deformation 409
Summary 409
STENT RECOIL 410
Acute Versus Chronic Stent Recoil 410
Clinical Impact and Treatment of Stent Recoil 411
TISSUE PROLAPSE 411
Incidence and Causes of Tissue Prolapse 411
Clinical Impact and Treatment of Tissue Prolapse 411
Summary 411
SUMMARY 412
REFERENCES 412