State-of-the-art and outlook of drug-eluting stents_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Wenyang ¹ , ZHOU Yanyi ¹ , ZHANG Yaoming ² , GU Hao ¹ , QU Ruisheng ¹ , CUI Chaoqiang ¹ ,  ZHOU Dong ¹

1. Department of Vascular Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, P. R. China;
2. Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730030, P. R. China;

Corresponding author：

ZHOU Dong, Email: 13919951166@163.com

Keywords：

Drug-eluting stent; coating; polymer; review

DOI：

10.7507/1007-4848.202012012

Video：

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Implantation of drug-eluting stents (DES) is one of the most effective treatment for intraluminal vascular diseases such as vascular stenosis caused by atherosclerosis. Antiproliferative drugs offered by could significantly reduce the restenosis of blood vessels, which is beneficial to interventional therapy in more advanced and complex vascular diseases. This review sumarizes the state-of-the-art of the DES based on the function of loaded drug and material of the stents. We hope this review can provide basic information of DES for clinicians and researchers to make more rational choices in practical applications. Moreover, this review also propses the prospects of drug-loaded stents.

Citation： HE Wenyang, ZHOU Yanyi, ZHANG Yaoming, GU Hao, QU Ruisheng, CUI Chaoqiang, ZHOU Dong. State-of-the-art and outlook of drug-eluting stents. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 930-934. doi: 10.7507/1007-4848.202012012 Copy

1.	Ozaki Y, Garcia-Garcia HM, Shlofmitz E, et al. Second-generation drug-eluting resorbable magnesium scaffold: Review of the clinical evidence. Cardiovasc Revasc Med, 2020, 21(1): 127-136.
2.	Kufner S, Sorges J, Mehilli J, et al. Randomized trial of polymer-free sirolimus- and probucol-eluting stents versus durable polymer zotarolimus-eluting stents: 5-year results of the isar-test-5 trial. JACC Cardiovasc Interv, 2016, 9(8): 784-792.
3.	Pendyala LK, Matsumoto D, Shinke T, et al. Nobori stent shows less vascular inflammation and early recovery of endothelial function compared with Cypher stent. JACC Cardiovasc Interv, 2012, 5(4): 436-444.
4.	Yang Y, Gao P, Wang J, et al. Endothelium-mimicking multifunctional coating modified cardiovascular stents via a stepwise metal-catechol-(amine) surface engineering strategy. Research (Wash DC), 2020, 2020: 9203906.
5.	Costopoulos C, Latib A, Naganuma T, et al. Newly available and recent advances in drug-eluting stents. Expert Rev Cardiovasc Ther, 2013, 11(5): 555-566.
6.	Gupta ML, Bode CJ, Georg GI, et al. Understanding tubulin-Taxol interactions: Mutations that impart Taxol binding to yeast tubulin. Proc Natl Acad Sci U S A, 2003, 100(11): 6394-6397.
7.	Murase S, Suzuki Y, Yamaguchi T, et al. The relationship between re-endothelialization and endothelial function after DES implantation: Comparison between paclitaxcel eluting stent and zotarolims eluting stent. Catheter Cardiovasc Interv, 2014, 83(3): 412-417.
8.	Aoki J, Serruys PW, van Beusekom H, et al. Endothelial progenitor cell capture by stents coated with antibody against CD34: The HEALING-FIM (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth-First In Man) Registry. J Am Coll Cardiol, 2005, 45(10): 1574-1579.
9.	Park KS, Kang SN, Kim DH, et al. Late endothelial progenitor cell-capture stents with CD146 antibody and nanostructure reduce in-stent restenosis and thrombosis. Acta Biomater, 2020, 111: 91-101.
10.	Hertault A, Chai F, Maton M, et al. In vivo evaluation of a pro-healing polydopamine coated stent through an in-stent restenosis rat model. Biomater Sci, 2021, 9(1): 212-220.
11.	Li C, Li Q, Mei Q, et al. Pharmacological effects and pharmacokinetic properties of icariin, the major bioactive component in Herba Epimedii. Life Sci, 2015, 126: 57-68.
12.	Yang J, Wei K, Wang Y, et al. Construction of a small-caliber tissue-engineered blood vessel using icariin-loaded β-cyclodextrin sulfate for in situ anticoagulation and endothelialization. Sci China Life Sci, 2018, 61(10): 1178-1188.
13.	Su LC, Chen YH, Chen MC. Dual drug-eluting stents coated with multilayers of hydrophobic heparin and sirolimus. ACS Appl Mater Interfaces, 2013, 5(24): 12944-12953.
14.	Gambini J, Inglés M, Olaso G, et al. Properties of Resveratrol: In vitro and in vivo studies about metabolism, bioavailability, and biological effects in animal models and humans. Oxid Med Cell Longev, 2015, 2015: 837042.
15.	Mnjoyan ZH, Fujise K. Profound negative regulatory effects by resveratrol on vascular smooth muscle cells: A role of p53-p21(WAF1/CIP1) pathway. Biochem Biophys Res Commun, 2003, 311(2): 546-552.
16.	Asadpour S, Yeganeh H, Khademi F, et al. Resveratrol-loaded polyurethane nanofibrous scaffold: Viability of endothelial and smooth muscle cells. Biomed Mater, 2019, 15(1): 015001.
17.	Zhang J, Liu Y, Luo R, et al. In vitro hemocompatibility and cytocompatibility of dexamethasone-eluting PLGA stent coatings. Applied Surface Science, 2015, 328: 154-162.
18.	Qiu H, Qi P, Liu J, et al. Biomimetic engineering endothelium-like coating on cardiovascular stent through heparin and nitric oxide-generating compound synergistic modification strategy. Biomaterials, 2019, 207: 10-22.
19.	Jean-Baptiste E, Blanchemain N, Neut C, et al. Evaluation of the anti-infectious properties of polyester vascular prostheses functionalised with cyclodextrin. J Infect, 2014, 68(2): 116-124.
20.	Rizas KD, Mehilli J. Stent polymers: Do they make a difference? Circ Cardiovasc Interv, 2016, 9(6): e002943.
21.	Forrest JK, Lansky AJ, Meller SM, et al. Evaluation of XIENCE V everolimus-eluting and Taxus Express2 paclitaxel-eluting coronary stents in patients with jailed side branches from the SPIRIT Ⅳ trial at 2 years. Am J Cardiol, 2013, 111(11): 1580-1586.
22.	Sharma A, Sharma SK, Vallakati A, et al. Duration of dual antiplatelet therapy after various drug-eluting stent implantation. Int J Cardiol, 2016, 215: 157-166.
23.	Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: A collaborative network meta-analysis. Lancet, 2007, 370(9591): 937-948.
24.	von Birgelen C, Kok MM, van der Heijden LC, et al. Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): A three-arm, randomised, non-inferiority trial. Lancet, 2016, 388(10060): 2607-2617.
25.	Pauck RG, Reddy BD. Computational analysis of the radial mechanical performance of PLLA coronary artery stents. Med Eng Phys, 2015, 37(1): 7-12.
26.	Mehilli J. Degradable polymer drug-eluting stents: A durable benefit? Lancet, 2013, 381(9867): 607-609.
27.	Fu Y, Tan L, Meng L, et al. Therapeutic effects of paclitaxel loaded polyethylene glycol-polylactic acid-glycolic acid copolymer nanoparticles on pancreatic cancer in rats. J Nanosci Nanotechnol, 2020, 20(12): 7271-7275.
28.	Gutiérrez-Chico JL, van Geuns RJ, Regar E, et al. Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: An optical coherence tomography substudy from the RESOLUTE All Comers trial. Eur Heart J, 2011, 32(19): 2454-2463.
29.	Hasebe T, Yohena S, Kamijo A, et al. Fluorine doping into diamond-like carbon coatings inhibits protein adsorption and platelet activation. J Biomed Mater Res A, 2007, 83(4): 1192-1199.
30.	Stefanini GG, Byrne RA, Serruys PW, et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: A pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J, 2012, 33(10): 1214-1222.
31.	Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thromb Haemost, 2011, 106(4): 572-584.
32.	Généreux P, Kumsars I, Schneider JE, et al. Dedicated bifurcation stent for the treatment of bifurcation lesions involving large side branches: Outcomes from the tryton confirmatory study. JACC Cardiovasc Interv, 2016, 9(13): 1338-1346.
33.	Hausleiter J, Kastrati A, Wessely R, et al. Prevention of restenosis by a novel drug-eluting stent system with a dose-adjustable, polymer-free, on-site stent coating. Eur Heart J, 2005, 26(15): 1475-1481.
34.	Worthley SG, Abizaid A, Kirtane AJ, et al. First-in-human evaluation of a novel polymer-free drug-filled stent: Angiographic, IVUS, OCT, and clinical outcomes from the revelution study. JACC Cardiovasc Interv, 2017, 10(2): 147-156.
35.	Serruys PW, Chevalier B, Sotomi Y, et al. Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB Ⅱ): A 3 year, randomised, controlled, single-blind, multicentre clinical trial. Lancet, 2016, 388(10059): 2479-2491.
36.	Hart DR, Fabi SG, White WM, et al. Current concepts in the use of PLLA: Clinical synergy noted with combined use of microfocused ultrasound and poly-l-lactic acid on the face, neck, and décolletage. Plast Reconstr Surg, 2015, 136(5 Suppl): 180S-187S.
37.	Makadia HK, Siegel SJ. Poly lactic-co-glycolic acid (PLGA) as biodegradable controlled drug delivery carrier. Polymers (Basel), 2011, 3(3): 1377-1397.
38.	Ormiston JA, Serruys PW, Regar E, et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): A prospective open-label trial. Lancet, 2008, 371(9616): 899-907.
39.	Tenekecioglu E, Farooq V, Bourantas CV, et al. Bioresorbable scaffolds: A new paradigm in percutaneous coronary intervention. BMC Cardiovasc Disord, 2016, 16: 38.
40.	Hytönen JP, Taavitsainen J, Tarvainen S, et al. Biodegradable coronary scaffolds: Their future and clinical and technological challenges. Cardiovasc Res, 2018, 114(8): 1063-1072.
41.	Yang J, Cui F, Lee IS. Surface modifications of magnesium alloys for biomedical applications. Ann Biomed Eng, 2011, 39(7): 1857-1871.
42.	Díaz JF, Camacho S. Magmaris resorbable magnesium scaffolds: Are they here to stay? Rev Port Cardiol, 2020, 39(8): 427-429.
43.	Haude M, Ince H, Kische S, et al. Safety and clinical performance of a drug eluting absorbable metal scaffold in the treatment of subjects with de novo lesions in native coronary arteries: Pooled 12-month outcomes of BIOSOLVE-Ⅱ and BIOSOLVE-Ⅲ. Catheter Cardiovasc Interv, 2018, 92(7): E502-E511.
44.	Purushottam B, Tuma JL, Krishnan P. Commentary: Leave nothing behind: No stent, no restenosis, no mortality. J Endovasc Ther, 2020, 27(5): 706-713.

1. Ozaki Y, Garcia-Garcia HM, Shlofmitz E, et al. Second-generation drug-eluting resorbable magnesium scaffold: Review of the clinical evidence. Cardiovasc Revasc Med, 2020, 21(1): 127-136.
2. Kufner S, Sorges J, Mehilli J, et al. Randomized trial of polymer-free sirolimus- and probucol-eluting stents versus durable polymer zotarolimus-eluting stents: 5-year results of the isar-test-5 trial. JACC Cardiovasc Interv, 2016, 9(8): 784-792.
3. Pendyala LK, Matsumoto D, Shinke T, et al. Nobori stent shows less vascular inflammation and early recovery of endothelial function compared with Cypher stent. JACC Cardiovasc Interv, 2012, 5(4): 436-444.
4. Yang Y, Gao P, Wang J, et al. Endothelium-mimicking multifunctional coating modified cardiovascular stents via a stepwise metal-catechol-(amine) surface engineering strategy. Research (Wash DC), 2020, 2020: 9203906.
5. Costopoulos C, Latib A, Naganuma T, et al. Newly available and recent advances in drug-eluting stents. Expert Rev Cardiovasc Ther, 2013, 11(5): 555-566.
6. Gupta ML, Bode CJ, Georg GI, et al. Understanding tubulin-Taxol interactions: Mutations that impart Taxol binding to yeast tubulin. Proc Natl Acad Sci U S A, 2003, 100(11): 6394-6397.
7. Murase S, Suzuki Y, Yamaguchi T, et al. The relationship between re-endothelialization and endothelial function after DES implantation: Comparison between paclitaxcel eluting stent and zotarolims eluting stent. Catheter Cardiovasc Interv, 2014, 83(3): 412-417.
8. Aoki J, Serruys PW, van Beusekom H, et al. Endothelial progenitor cell capture by stents coated with antibody against CD34: The HEALING-FIM (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth-First In Man) Registry. J Am Coll Cardiol, 2005, 45(10): 1574-1579.
9. Park KS, Kang SN, Kim DH, et al. Late endothelial progenitor cell-capture stents with CD146 antibody and nanostructure reduce in-stent restenosis and thrombosis. Acta Biomater, 2020, 111: 91-101.
10. Hertault A, Chai F, Maton M, et al. In vivo evaluation of a pro-healing polydopamine coated stent through an in-stent restenosis rat model. Biomater Sci, 2021, 9(1): 212-220.
11. Li C, Li Q, Mei Q, et al. Pharmacological effects and pharmacokinetic properties of icariin, the major bioactive component in Herba Epimedii. Life Sci, 2015, 126: 57-68.
12. Yang J, Wei K, Wang Y, et al. Construction of a small-caliber tissue-engineered blood vessel using icariin-loaded β-cyclodextrin sulfate for in situ anticoagulation and endothelialization. Sci China Life Sci, 2018, 61(10): 1178-1188.
13. Su LC, Chen YH, Chen MC. Dual drug-eluting stents coated with multilayers of hydrophobic heparin and sirolimus. ACS Appl Mater Interfaces, 2013, 5(24): 12944-12953.
14. Gambini J, Inglés M, Olaso G, et al. Properties of Resveratrol: In vitro and in vivo studies about metabolism, bioavailability, and biological effects in animal models and humans. Oxid Med Cell Longev, 2015, 2015: 837042.
15. Mnjoyan ZH, Fujise K. Profound negative regulatory effects by resveratrol on vascular smooth muscle cells: A role of p53-p21(WAF1/CIP1) pathway. Biochem Biophys Res Commun, 2003, 311(2): 546-552.
16. Asadpour S, Yeganeh H, Khademi F, et al. Resveratrol-loaded polyurethane nanofibrous scaffold: Viability of endothelial and smooth muscle cells. Biomed Mater, 2019, 15(1): 015001.
17. Zhang J, Liu Y, Luo R, et al. In vitro hemocompatibility and cytocompatibility of dexamethasone-eluting PLGA stent coatings. Applied Surface Science, 2015, 328: 154-162.
18. Qiu H, Qi P, Liu J, et al. Biomimetic engineering endothelium-like coating on cardiovascular stent through heparin and nitric oxide-generating compound synergistic modification strategy. Biomaterials, 2019, 207: 10-22.
19. Jean-Baptiste E, Blanchemain N, Neut C, et al. Evaluation of the anti-infectious properties of polyester vascular prostheses functionalised with cyclodextrin. J Infect, 2014, 68(2): 116-124.
20. Rizas KD, Mehilli J. Stent polymers: Do they make a difference? Circ Cardiovasc Interv, 2016, 9(6): e002943.
21. Forrest JK, Lansky AJ, Meller SM, et al. Evaluation of XIENCE V everolimus-eluting and Taxus Express2 paclitaxel-eluting coronary stents in patients with jailed side branches from the SPIRIT Ⅳ trial at 2 years. Am J Cardiol, 2013, 111(11): 1580-1586.
22. Sharma A, Sharma SK, Vallakati A, et al. Duration of dual antiplatelet therapy after various drug-eluting stent implantation. Int J Cardiol, 2016, 215: 157-166.
23. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: A collaborative network meta-analysis. Lancet, 2007, 370(9591): 937-948.
24. von Birgelen C, Kok MM, van der Heijden LC, et al. Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): A three-arm, randomised, non-inferiority trial. Lancet, 2016, 388(10060): 2607-2617.
25. Pauck RG, Reddy BD. Computational analysis of the radial mechanical performance of PLLA coronary artery stents. Med Eng Phys, 2015, 37(1): 7-12.
26. Mehilli J. Degradable polymer drug-eluting stents: A durable benefit? Lancet, 2013, 381(9867): 607-609.
27. Fu Y, Tan L, Meng L, et al. Therapeutic effects of paclitaxel loaded polyethylene glycol-polylactic acid-glycolic acid copolymer nanoparticles on pancreatic cancer in rats. J Nanosci Nanotechnol, 2020, 20(12): 7271-7275.
28. Gutiérrez-Chico JL, van Geuns RJ, Regar E, et al. Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: An optical coherence tomography substudy from the RESOLUTE All Comers trial. Eur Heart J, 2011, 32(19): 2454-2463.
29. Hasebe T, Yohena S, Kamijo A, et al. Fluorine doping into diamond-like carbon coatings inhibits protein adsorption and platelet activation. J Biomed Mater Res A, 2007, 83(4): 1192-1199.
30. Stefanini GG, Byrne RA, Serruys PW, et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: A pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J, 2012, 33(10): 1214-1222.
31. Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thromb Haemost, 2011, 106(4): 572-584.
32. Généreux P, Kumsars I, Schneider JE, et al. Dedicated bifurcation stent for the treatment of bifurcation lesions involving large side branches: Outcomes from the tryton confirmatory study. JACC Cardiovasc Interv, 2016, 9(13): 1338-1346.
33. Hausleiter J, Kastrati A, Wessely R, et al. Prevention of restenosis by a novel drug-eluting stent system with a dose-adjustable, polymer-free, on-site stent coating. Eur Heart J, 2005, 26(15): 1475-1481.
34. Worthley SG, Abizaid A, Kirtane AJ, et al. First-in-human evaluation of a novel polymer-free drug-filled stent: Angiographic, IVUS, OCT, and clinical outcomes from the revelution study. JACC Cardiovasc Interv, 2017, 10(2): 147-156.
35. Serruys PW, Chevalier B, Sotomi Y, et al. Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB Ⅱ): A 3 year, randomised, controlled, single-blind, multicentre clinical trial. Lancet, 2016, 388(10059): 2479-2491.
36. Hart DR, Fabi SG, White WM, et al. Current concepts in the use of PLLA: Clinical synergy noted with combined use of microfocused ultrasound and poly-l-lactic acid on the face, neck, and décolletage. Plast Reconstr Surg, 2015, 136(5 Suppl): 180S-187S.
37. Makadia HK, Siegel SJ. Poly lactic-co-glycolic acid (PLGA) as biodegradable controlled drug delivery carrier. Polymers (Basel), 2011, 3(3): 1377-1397.
38. Ormiston JA, Serruys PW, Regar E, et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): A prospective open-label trial. Lancet, 2008, 371(9616): 899-907.
39. Tenekecioglu E, Farooq V, Bourantas CV, et al. Bioresorbable scaffolds: A new paradigm in percutaneous coronary intervention. BMC Cardiovasc Disord, 2016, 16: 38.
40. Hytönen JP, Taavitsainen J, Tarvainen S, et al. Biodegradable coronary scaffolds: Their future and clinical and technological challenges. Cardiovasc Res, 2018, 114(8): 1063-1072.
41. Yang J, Cui F, Lee IS. Surface modifications of magnesium alloys for biomedical applications. Ann Biomed Eng, 2011, 39(7): 1857-1871.
42. Díaz JF, Camacho S. Magmaris resorbable magnesium scaffolds: Are they here to stay? Rev Port Cardiol, 2020, 39(8): 427-429.
43. Haude M, Ince H, Kische S, et al. Safety and clinical performance of a drug eluting absorbable metal scaffold in the treatment of subjects with de novo lesions in native coronary arteries: Pooled 12-month outcomes of BIOSOLVE-Ⅱ and BIOSOLVE-Ⅲ. Catheter Cardiovasc Interv, 2018, 92(7): E502-E511.
44. Purushottam B, Tuma JL, Krishnan P. Commentary: Leave nothing behind: No stent, no restenosis, no mortality. J Endovasc Ther, 2020, 27(5): 706-713.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

State-of-the-art and outlook of drug-eluting stents

Abstract Full text Figures/Tables Video References Cited by

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