Mechanical properties and performances of contemporary drug-eluting stent: focus on the metallic backbone

Introduction: Drug-eluting stents (DES) are still the standard of care in percutaneous coronary intervention (PCI) since the fall of bioresorbable scaffolds with respect to safety. The unbeatable advantage of a metallic stent when compared with a scaffold is a stronger mechanical property and more sustainable vascular support. Recent development of contemporary metallic stent has focused on the reduction of strut thickness. However, there will always be a trade-off between improvement in deliverability, flexibility, and radial strength. Areas covered: This review aims to discuss the designs of metallic stent platform and mechanical properties as well as mechanical performance of contemporary DES from bench studies and clinical trials. Expert opinion: Mechanical properties of stents affect short- and long-term clinical outcomes. Ultrathin-strut DES have become popular and clinical trials have shown impressive results. Thinner struts may improve device flexibility and deliverability but the radial strength and longitudinal integrity might have been compromised as well. Ultrathin-strut cobalt chromium or platinum chromium DES will become standard of care in PCI practice in the near future. Information on the stent design, stent material and mechanical properties of the stent are essential for a rational selection of the appropriate stent in selected lesions and patients.

引言：药物洗脱支架（DES）自生物可吸收支架因安全性问题而退潮以来，一直作为经皮冠状动脉介入治疗（PCI）的标准治疗方案。与支架相比，金属支架的无与伦比的优势在于其更强的机械性能和更持久的血管支持。近年来，现代金属支架的发展主要集中在降低支架梁的厚度。然而，在提升可输送性、柔韧性和径向强度之间始终存在权衡。涵盖范围：本综述旨在探讨现代金属支架平台的设计、机械性能以及从基础研究和临床试验中获得的当代药物洗脱支架的机械性能。专家观点：支架的机械性能影响短期和长期临床结果。超薄梁药物洗脱支架已广受欢迎，临床试验也显示出了令人瞩目的成果。更薄的支架梁可能改善器械的柔韧性和可输送性，但径向强度和纵向完整性可能也会受到影响。超薄梁钴铬或铂铬药物洗脱支架将在未来PCI实践中成为标准治疗方案。关于支架设计、支架材料和支架机械性能的信息对于合理选择适用于特定病变和患者的支架至关重要。