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Biodegradable coronary stent: a new era in interventional cardiology Volume 23, issue 9, Novembre 2011

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Authors
Université Paris Diderot, laboratoire Matière et systèmes complexes, CNRS UMR 7057, 10 rue Alice Domont et Léonie Duquet, 75205 Paris Cedex 13

There have been several major developments in interventional cardiology over the past 30 years such as the introduction of balloon angioplasty in the late nineteen seventies. Several years later, significant improvements were achieved in terms of reducing the incidence of reintervention by the introduction of coronary stents. These metallic intravascular devices were considered to be the gold standard in terms of management of high risk, stable angina. However, they had one major limitation – in-stent restenosis, responsible for a 20% binary restenosis rate at 6 months. This phenomenon resulted in many reinterventions and substantial morbidity. At the beginning of the new millennium, interventional cardiology underwent a third revolution when drug eluting stents (DES) were first introduced by Johnson&Johnson's subsidiary, Cordis. These devices diffuse anti-proliferative drugs from a polymeric coating on the surface of the metal scaffold over a period of several weeks. Widely used at first, DES have somehow been disavowed because of rising concerns about their safety. Despite a binary restenosis rate of 0%, a trend to increased mortality was observed explained by the occurrence of late and very late stent thrombosis. To counteract this problem, the industry then deployed important efforts to develop a biodegradable coronary stent with a fully degradable scaffold once the endovascular support becomes unnecessary (a period of 3-4 months). Several biodegradable coronary stents are actually under development and are undergoing clinical trials. These include the BVS by ABBOTT Laboratories, AMS by Biotronik, IDEAL by Bioabsorbable therapeutics, ReZolve by REVA Medical and the Igaki-Tamai stent. Some other coronary stents under development are also discussed in this review.