Intravascular Stents in the Last and the Next 10 Years

The first balloon-expandable coronary stent was approved “for the prevention of restenosis” in 1994, the same year that the Journal of Endovascular Therapy was inaugurated. Since then, the development of the stent has paralleled the evolution of endovascular intervention as a new specialty. Innovators have pushed to explore new and varied stent applications outside the coronary arteries. Carotid stenting, transjugular intrahepatic portocaval shunts, and covered stents are a few of these new applications that have now become commonplace. Dozens of stent designs and several new materials have been tested to solve the problem of in-stent restenosis, but it is the drug-eluting stent (DES) that has emerged as the most promising, at least in the coronary arteries. However, the benefits of DES technology are not likely to be effective in the more pervasive forms of in-stent restenosis, such as encountered in the femoropopliteal segment. In the future, technologies aimed at stimulating rather than inhibiting tissue response to an implant may be part of the next wave of developments, as we take aim against the poor and/or slow tissue incorporation that manifests as leaks and dislodgement. In the superficial femoral artery, for example, mechanical stresses that cause fractures and dislocations may be addressed by using a very flexible endovascular device with a tissue-friendly inner surface that promotes rapid stent endothelialization to counter the biological effects of motion and microtrauma. The rapidly developing fields of nanotechnology, microelectronics, and advanced materials technology will enable the surface engineer to design molecular-specific surfaces for a new generation of vascular devices. Interactive implantable or injectable microdevices aimed at providing specific information upon demand from an external source will revolutionize disease prevention, as emphasis shifts toward monitoring cardiovascular risk exposure. There is no doubt that during the next 10 years, we will witness impressive technological progress in the field of cardiovascular implantable devices.