Implants médicaux et chirurgie

Abstrait

Stents: A Comprehensive Overview

Raju Kapoor

Stents have emerged as crucial medical devices in the field of interventional cardiology and vascular medicine, playing a pivotal role in the treatment of various cardiovascular and non-cardiovascular conditions. This comprehensive overview aims to provide a detailed examination of stents, encompassing their historical evolution, design characteristics, deployment techniques, clinical applications, complications, and future prospects. The historical evolution of stents traces back to the pioneering work in the mid-20th century, with significant advancements in material science and engineering contributing to the development of diverse stent designs. This overview delves into the structural components of stents, including the materials used, coating technologies, and the influence of biomechanical factors on stent performance. Additionally, it explores the evolution from bare-metal stents to drug-eluting stents and bioresorbable scaffolds, highlighting the impact of these innovations on clinical outcomes. The deployment techniques of stents are a critical aspect of their successful application. This overview comprehensively discusses the various methods employed in stent deployment, such as balloon angioplasty, self-expanding stents, and bioresorbable scaffolds. Furthermore, it examines the role of imaging modalities, such as intravascular ultrasound and optical coherence tomography, in guiding stent placement and optimizing procedural outcomes. Clinical applications of stents extend beyond coronary artery disease, encompassing peripheral artery disease, biliary and ureteral strictures, and neurovascular interventions. This review provides an in-depth analysis of the evidence supporting stent use in these diverse clinical scenarios, evaluating the efficacy and safety profiles. Moreover, it discusses emerging applications in areas such as transcatheter valve therapies and endovascular aneurysm repair. Despite their widespread use, stents are associated with complications, including in-stent restenosis, thrombosis, and stent fracture. This overview critically evaluates the factors contributing to these complications and explores strategies for their prevention and management. Additionally, it addresses the impact of patient-specific factors, such as diabetes and chronic kidney disease, on stent outcomes.