Stents the Heroes of Angioplasty discover the powers of third generation stents

The heroes of coronary angioplasty, stents are the mesh metallic tubes that keep the dilated artery open, restoring normal blood flow to the heart. As angioplasty became standard procedure all over the world, stent technology too advanced in leaps and bounds. Stents have become sleek, absorbable and deliverable to the most tortuous and distal vessels facilitating multi-vessel angioplasty as a viable alternative to bypass surgery in the vast majority of patients.

Stainless steel and beyond

The original Bare-Metal stents were made of stainless steel. They were bulky and difficult to manipulate in hard-to-reach vessels. There was always the danger of restenosis (the narrowing came back). The first key development since then was in the material the stents were made of. Stents made from alloys such as platinum-chromium and cobalt chromium were more visible and deliverable, with less chances for a recurrence of narrowing. However narrowing still occurred. To combat this came the next big leap that revolutionized the field of coronary angioplasty – the development of Drug-Eluting Stents (DES).

Stents that disperse medication

DES had special drugs applied on them so that the narrowing did not recur (or did very rarely) Since then Drug-Eluting technology has developed significantly accounting for the vast majority of stents implanted today. Again, the early DES were difficult to deliver as they were bulky. This has been overcome by the third generation DES, now available with much thinner struts. In fact, we are now on the threshold of fourth generation, fully absorbable DES.

Viable option to Bypass surgery

Other advances include the development of special stents for branches in the coronary vessels. These were difficult to treat as sometimes the branches closed off. We now however, have special stents with side branches (various configurations) that are designed specifically for this.This coupled with advances in imaging such as OCT (Optical Coherence Tomography) have enabled the use of coronary angioplasty in patients who would normally be referred for a Bypass Surgery

Dr. Nandakumar Ramasami
MBBS, MRCP (UK), CCT (Cardio) UK
Interventional Cardiologist
MIOT Heart Revive Center