K Nakamura, MD; JH Keating, DVM; ER Edelman, MD, PhD. Pathology of Endovascular Stents.
Summary: Coronary artery disease (CAD) represents the leading cause of death worldwide, attributed to more than 17.5 million deaths annually, accounting for approximately 1 of every 3 deaths. In the United States, contemporary decreases in CAD-related mortality correlate with the 2 decades after the Surgeon General report on the ills of tobacco, the Framingham Heart Study identification of cardiac risk factors with lifestyle modification, and the widespread acceptance and accessibility of evidence-based use of percutaneous coronary intervention (PCI). The technologies underpinning PCI have evolved iteratively from balloon angioplasty to increasingly advanced metallic stent platforms with various drug chemistries to self-degrading nonmetallic scaffolds. Large-scale clinical trials have validated the safety and efficacy of successive generations of stents. Equally important preclinical and pathology studies provide complementary insight to reconcile adverse events; refine clinical protocols, such as optimal use of antithrombotic therapy; and drive innovation for development of next-generation stents.