Closed-cell: Every stent segment connected by link
Less flexible, may develop kinks
Occasional incomplete expansion
Better radial force/intravascular scaffolding
Open-cell: Some stent segment connections absent
Conforms to angled vessels/tortuous anatomy
Less radial force/intravascular scaffolding
Vascular stent technologies
Balloon-mounted: Externally mounted on percutaneous transluminal angioplasty (PTA) balloon
Risk of dislodgement; prevent by introducing through guiding catheter/sheath
Balloon inflation to deploy stent
Somewhat variable diameter range
More rigid stent design
Conforms poorly to changing vessel diameters
Balloon-mounted stent delivery designs
Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen for balloon inflation/deflation during stent deployment
Rapid-exchange (monorail): Guidewire passes through balloon, exits catheter proximal to balloon, runs alongside catheter shaft
Self-expanding: Sheathed in retractable delivery system; spontaneously expands after retraction
Most frequently constructed from nitinol
Alloy regains original shape when no longer compressed/constrained
Requires appropriate oversizing to achieve secure intravascular fixation
Typically more flexible
Conforms to changing vessel diameters
Drug-eluting: Stent coated with medication (e.g., paclitaxel)
Delivers antiproliferative drug to vessel surface
Local drug prevents in-stent stenosis
Drug reduces neointimal proliferation
More variable results when treating PAD versus coronary drug-eluting stents (DES)
No benefit over self-expanding stents in superficial femoral artery (SFA)
Ongoing investigational studies
Biodegradable: Made of polymers/metal alloys ± drug coating
Scaffold artery, allows natural healing to occur
Subsequently biodegrades; may deliver sustained drug release as degradation proceeds
Several biodegradable stents in clinical trials
Many more at preclinical stage of development
Radioactive: Catheter-based intravascular brachytherapy, mainly from gamma/beta sources
Majority of studies relate to coronary arteries
High restenosis incidence at stent margins
Ongoing investigational studies
Covered (stent-graft): Metallic intravascular stent combined with fabric graft of either Dacron or expanded polytetrafluoroethylene (ePTFE)
Courses inside vascular lumen; redirects blood flow through device rather than native vessel
Bard Fluency (Bard; Tempe, AZ): Self-expanding nitinol stent encapsulated with ePTFE; retractable delivery system
Gore Viabahn (WL Gore; Newark, DE): Inner ePTFE fabric graft attached to external self-expanding nitinol stent
PREPROCEDURE
Indications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Basavarajaiah S et al: Treatment of drug-eluting stent restenosis: comparison between drug-eluting balloon versus second-generation drug-eluting stents from a retrospective observational study. Catheter Cardiovasc Interv. 88(4):522-528, 2016
Liou K et al: Drug-eluting balloon versus second generation drug eluting stents in the treatment of in-stent restenosis: a systematic review and meta-analysis. Heart Lung Circ. 25(12):1184-1194, 2016
Naghi J et al: New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease. Med Devices (Auckl). 9:161-74, 2016
Carnelli D et al: Mechanical properties of open-cell, self-expandable shape memory alloy carotid stents. Artif Organs. 35(1):74-80, 2011
Räber L et al: Current status of drug-eluting stents. Cardiovasc Ther. 29(3):176-89, 2011
Arbabi A et al: Irradiation and dosimetry of Nitinol stent for renal artery brachytherapy. Appl Radiat Isot. 67(1):129-32, 2009
Brown DA et al: A new wave in treatment of vascular occlusive disease: biodegradable stents; clinical experience & scientific principles. J Vasc Interv Radiol. 20(3):315-24, 2009
Minar E et al: New stents for SFA. J Cardiovasc Surg (Torino). 50(5):635-45, 2009
Pierce DS et al: Open-cell versus closed-cell stent design differences in blood flow velocities after carotid stenting. J Vasc Surg. 49(3):602-6; discussion 606, 2009
Norgren L et al: Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 45 Suppl S:S5-67, 2007
Vaina S et al: Progressive stent technologies: new approaches for the treatment of cardiovascular diseases. Expert Opin Drug Deliv. 3(6):783-97, 2006
Duda SH et al: Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol. 16(3):331-8, 2005
Duerig TW et al: A comparison of balloon- and self-expanding stents. Minim Invasive Ther Allied Technol. 11(4):173-8, 2002
Taylor AJ et al: A comparison of four stent designs on arterial injury, cellular proliferation, neointima formation, and arterial dimensions in an experimental porcine model. Catheter Cardiovasc Interv. 53(3):420-5, 2001
Closed-cell: Every stent segment connected by link
Less flexible, may develop kinks
Occasional incomplete expansion
Better radial force/intravascular scaffolding
Open-cell: Some stent segment connections absent
Conforms to angled vessels/tortuous anatomy
Less radial force/intravascular scaffolding
Vascular stent technologies
Balloon-mounted: Externally mounted on percutaneous transluminal angioplasty (PTA) balloon
Risk of dislodgement; prevent by introducing through guiding catheter/sheath
Balloon inflation to deploy stent
Somewhat variable diameter range
More rigid stent design
Conforms poorly to changing vessel diameters
Balloon-mounted stent delivery designs
Over-the-wire (OTW): Central lumen for guidewire access/contrast injection, small parallel lumen for balloon inflation/deflation during stent deployment
Rapid-exchange (monorail): Guidewire passes through balloon, exits catheter proximal to balloon, runs alongside catheter shaft
Self-expanding: Sheathed in retractable delivery system; spontaneously expands after retraction
Most frequently constructed from nitinol
Alloy regains original shape when no longer compressed/constrained
Requires appropriate oversizing to achieve secure intravascular fixation
Typically more flexible
Conforms to changing vessel diameters
Drug-eluting: Stent coated with medication (e.g., paclitaxel)
Delivers antiproliferative drug to vessel surface
Local drug prevents in-stent stenosis
Drug reduces neointimal proliferation
More variable results when treating PAD versus coronary drug-eluting stents (DES)
No benefit over self-expanding stents in superficial femoral artery (SFA)
Ongoing investigational studies
Biodegradable: Made of polymers/metal alloys ± drug coating
Scaffold artery, allows natural healing to occur
Subsequently biodegrades; may deliver sustained drug release as degradation proceeds
Several biodegradable stents in clinical trials
Many more at preclinical stage of development
Radioactive: Catheter-based intravascular brachytherapy, mainly from gamma/beta sources
Majority of studies relate to coronary arteries
High restenosis incidence at stent margins
Ongoing investigational studies
Covered (stent-graft): Metallic intravascular stent combined with fabric graft of either Dacron or expanded polytetrafluoroethylene (ePTFE)
Courses inside vascular lumen; redirects blood flow through device rather than native vessel
Bard Fluency (Bard; Tempe, AZ): Self-expanding nitinol stent encapsulated with ePTFE; retractable delivery system
Gore Viabahn (WL Gore; Newark, DE): Inner ePTFE fabric graft attached to external self-expanding nitinol stent
PREPROCEDURE
Indications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Basavarajaiah S et al: Treatment of drug-eluting stent restenosis: comparison between drug-eluting balloon versus second-generation drug-eluting stents from a retrospective observational study. Catheter Cardiovasc Interv. 88(4):522-528, 2016
Liou K et al: Drug-eluting balloon versus second generation drug eluting stents in the treatment of in-stent restenosis: a systematic review and meta-analysis. Heart Lung Circ. 25(12):1184-1194, 2016
Naghi J et al: New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease. Med Devices (Auckl). 9:161-74, 2016
Carnelli D et al: Mechanical properties of open-cell, self-expandable shape memory alloy carotid stents. Artif Organs. 35(1):74-80, 2011
Räber L et al: Current status of drug-eluting stents. Cardiovasc Ther. 29(3):176-89, 2011
Arbabi A et al: Irradiation and dosimetry of Nitinol stent for renal artery brachytherapy. Appl Radiat Isot. 67(1):129-32, 2009
Brown DA et al: A new wave in treatment of vascular occlusive disease: biodegradable stents; clinical experience & scientific principles. J Vasc Interv Radiol. 20(3):315-24, 2009
Minar E et al: New stents for SFA. J Cardiovasc Surg (Torino). 50(5):635-45, 2009
Pierce DS et al: Open-cell versus closed-cell stent design differences in blood flow velocities after carotid stenting. J Vasc Surg. 49(3):602-6; discussion 606, 2009
Norgren L et al: Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 45 Suppl S:S5-67, 2007
Vaina S et al: Progressive stent technologies: new approaches for the treatment of cardiovascular diseases. Expert Opin Drug Deliv. 3(6):783-97, 2006
Duda SH et al: Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol. 16(3):331-8, 2005
Duerig TW et al: A comparison of balloon- and self-expanding stents. Minim Invasive Ther Allied Technol. 11(4):173-8, 2002
Taylor AJ et al: A comparison of four stent designs on arterial injury, cellular proliferation, neointima formation, and arterial dimensions in an experimental porcine model. Catheter Cardiovasc Interv. 53(3):420-5, 2001
STATdx includes over 200,000 searchable images, including x-ray, CT, MR and ultrasound images. To access all images, please log in or subscribe.