Development of coronary stents

The article is professionally consulted by MSc Nguyen Van Phong - Internal Medicine and Cardiology Interventionist, Cardiovascular Center - Vinmec Times City International General Hospital. The doctor has more than 15 years of experience in the field of cardiology.

Percutaneous coronary intervention is a technique that uses a catheter (catheter) through the skin to insert a small balloon into the angioplasty of the blocked coronary artery and place a stent to re-open the blood flow. Along with the improvement of technology, the development of new coronary stents has helped to solve the stenosis in the coronary arteries, helping to improve myocardial perfusion under all conditions of strenuous activity of the heart. patient.

The first coronary artery disease treatment was coronary artery bypass graft surgery performed in 1960. This is invasive surgery, using an artery or vein from another area of ​​the patient's body by bypass. from the aorta into the coronary artery. Surgery is usually performed when the patient's heart is temporarily stopped and cardiopulmonary resuscitation methods are used.
It was not until 1977 that coronary intervention was performed. This is a minimally invasive method that uses only a very small incision to insert the catheter at the balloon end, threading it to the point of obstruction. The balloon is then inflated to widen the blockage, restoring blood flow.
It was not until 1986 that coronary stents were used for the first time in France and approved by the FDA as an official treatment method in the US since 1994. Over the years, coronary stents have improved. significantly to meet the treatment needs of each patient:

The first coronary stents were made from bare metal, which acted only as a support and kept the coronary artery from collapsing after the catheter was removed. However, the ability to prevent restenosis of this type is quite low, with about 25% of patients having coronary re-stenosis within 6 months of intervention. By 1990 was the era of dual antiplatelet and the development of balloon-expanding stents, self-expanding stents. Drug-eluting stents are considered to be the third revolution in interventional cardiology because of their reduced risk of stent restenosis. A drug class to limit restenosis mounted on a metal stent has the potential to interrupt the subsequent re-stenosis process. This type of stent significantly reduces the risk of restenosis to less than 10% and is the best treatment for patients at high risk of coronary re-stenosis (especially patients with diabetes). The absorbable stent is the fourth revolution in interventional cardiology and is by far the most bioabsorbable stent. This type of stent is made of natural materials (no polymers) and the drug promotes natural healing by accelerating the growth of the arterial cell lining. Antibodies on the surface of biological stents stimulate the production of endothelial EPCs from the bone marrow, which accelerates the formation of healthy endothelium and reduces the risk of clot formation in both early and late stages of stent placement. Dual therapy stents (DTS) are the newest coronary stents, the first generation of therapeutic stents. This is a combination of the benefits of drug-eluting stents and bio-absorbable stents, not only reducing the risk of arterial restenosis but also assisting in the healing of intravascular lesions.

Currently, in Vietnam, there are many types of stents that are diverse in origin, price and quality. The simplest stent is a common stent with low cost but high re-stenosis potential, and is currently used very little. The second type is drug-eluting stents that reduce the risk of restenosis but are more expensive than conventional stents, which are widely used, and finally, bio-absorbable stents that can completely dissolve after 2 years but are expensive. and is still in the research process, so it is currently only used on some suitable patients. The variety of stents has created anxiety for patients not only about financial issues but also about stent quality and technician skills.
To provide cardiovascular patients with standard, scientific and asymptotic treatment programs in the US at a reasonable cost. Vinmec International General Hospital has implemented the first comprehensive cardiovascular treatment program in Vietnam. This program will help patients enjoy the full advantage of the package treatment model and receive the care of leading cardiologists. The current cardiovascular program at Vinmec, in addition to applying coronary interventional stenting techniques, also includes percutaneous aortic valve replacement, aortic-coronary bypass surgery to help patients treat Myocardial ischemia due to narrowing of the main coronary arteries and branches with a size greater than 1mm, minimizing the risk of coronary stents as well as the risk of restenosis after intervention.