Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents effectively prevented abrupt vessel closure but were limited by in-stent restenosis due to smooth muscle cell proliferation and neointimal hyperplasia. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over bare-metal stents as it mitigated the risk of in-stent restenosis. Nonetheless, they had several design limitations that increased the risk of late stent thrombosis. Significant advances in stent design, including thinner struts, enhanced polymers’ formulation, and more potent antiproliferative agents, have led to the introduction of new-generation DES with a superior safety profile. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. We conclude by discussing the clinical implications of stent design in high-risk subsets of patients.

中文翻译：

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药物洗脱冠状动脉支架的演变：从工作台到床边的来回旅程

冠状动脉支架彻底改变了冠状动脉疾病的治疗。与球囊血管成形术相比，裸金属支架有效地防止了突然的血管闭合，但由于平滑肌细胞增殖和新内膜增生而受到支架内再狭窄的限制。第一代药物洗脱支架 (DES) 具有抗增殖药物涂层，与裸金属支架相比具有显着优势，因为它降低了支架内再狭窄的风险。尽管如此，它们有几个设计限制，增加了晚期支架内血栓形成的风险。支架设计的重大进步，包括更细的支架、增强的聚合物配方和更有效的抗增殖剂，已导致引入具有卓越安全性的新一代 DES。心脏病专家有超过 20 种不同的 DES 类型可供选择，每个都有其独特的功能和特点。这篇综述重点介绍了支架设计的演变，并总结了不同类型支架的临床数据。最后，我们讨论了支架设计对高危患者亚群的临床意义。