Evolution of Coronary Stents: From Bare-Metal Stents to Fully Biodegradable, Drug-Eluting Stents

Coronary stenting represents the standard of care for percutaneous revascularization of symptomatic coronary artery disease. However, despite progress in the evolution of intravascular stents, clinical adverse events such as restenosis and stent thrombosis still represent the “achilles heel” of this ground-breaking technology. Of particular note was the association of these adverse events with the material, the polymer coating, and the active drug of currently approved drug eluting stents. Consequently, modifications were made to the design, coating, and the choice of drugs, eventually, resulting in (fully) biodegradable drug-eluting stents. Such stents offer the appealing concept of a temporary vascular scaffold and are currently under extensive preclinical and clinical investigation. However, biodegradable stents must demonstrate efficacy and safety in larger randomized clinical trials in real-world scenarios, which are currently on the horizon.