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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Synonyms
- Vascular endoprosthesis
Definitions
- Vascular stent: Catheter-mounted metallic intravascular prosthesis
- Provides intravascular scaffold
- Allows for endothelialization
- Endothelial cells migrate into stent
- Leads to in-stent restenosis
- Provides intravascular rigidity
- Compresses atheroma, dissection flaps
- Resists elastic recoil
- Allows for endothelialization
- Placed in diseased vascular structures
- Arteries
- Pulmonary arteries
- Veins
- Portal veins
- Various indications
- Recanalization of luminal stenosis/occlusion, including
- Arterial atherosclerotic plaque [e.g., peripheral arterial disease (PAD), chronic mesenteric ischemia]
- Venous extrinsic compression (e.g., May-Thurner syndrome)
- Intimal hyperplasia (e.g., hemodialysis access outflow narrowing)
- Aneurysm/pseudoaneurysm exclusion
- Traumatic/iatrogenic arterial perforation
- Arteriovenous (AV) communications
- Stent-assisted coil embolization
- Recanalization of luminal stenosis/occlusion, including
- Provides intravascular scaffold
- Various delivery systems/calibers
- 0.035" delivery system
- 0.014"/0.018" delivery system
- Vascular stent designs
- 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
- Closed-cell: Every stent segment connected by link
- 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
- Risk of dislodgement; prevent by introducing through guiding catheter/sheath
- 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
- Most frequently constructed from nitinol
- 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
- Delivers antiproliferative drug to vessel surface
- 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
- Scaffold artery, allows natural healing to occur
- 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
- Radial force of metallic stent secures graft
- Catheter-mounted delivery system
- 3 FDA-approved peripheral stent grafts
- Atrium iCAST (Atrium Medical; Hudson, NH): Balloon-mounted expandable ePTFE stent graft
- 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
- Courses inside vascular lumen; redirects blood flow through device rather than native vessel
- Balloon-mounted: Externally mounted on percutaneous transluminal angioplasty (PTA) balloon
- Vascular stent: Catheter-mounted metallic intravascular prosthesis
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
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Synonyms
- Vascular endoprosthesis
Definitions
- Vascular stent: Catheter-mounted metallic intravascular prosthesis
- Provides intravascular scaffold
- Allows for endothelialization
- Endothelial cells migrate into stent
- Leads to in-stent restenosis
- Provides intravascular rigidity
- Compresses atheroma, dissection flaps
- Resists elastic recoil
- Allows for endothelialization
- Placed in diseased vascular structures
- Arteries
- Pulmonary arteries
- Veins
- Portal veins
- Various indications
- Recanalization of luminal stenosis/occlusion, including
- Arterial atherosclerotic plaque [e.g., peripheral arterial disease (PAD), chronic mesenteric ischemia]
- Venous extrinsic compression (e.g., May-Thurner syndrome)
- Intimal hyperplasia (e.g., hemodialysis access outflow narrowing)
- Aneurysm/pseudoaneurysm exclusion
- Traumatic/iatrogenic arterial perforation
- Arteriovenous (AV) communications
- Stent-assisted coil embolization
- Recanalization of luminal stenosis/occlusion, including
- Provides intravascular scaffold
- Various delivery systems/calibers
- 0.035" delivery system
- 0.014"/0.018" delivery system
- Vascular stent designs
- 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
- Closed-cell: Every stent segment connected by link
- 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
- Risk of dislodgement; prevent by introducing through guiding catheter/sheath
- 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
- Most frequently constructed from nitinol
- 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
- Delivers antiproliferative drug to vessel surface
- 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
- Scaffold artery, allows natural healing to occur
- 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
- Radial force of metallic stent secures graft
- Catheter-mounted delivery system
- 3 FDA-approved peripheral stent grafts
- Atrium iCAST (Atrium Medical; Hudson, NH): Balloon-mounted expandable ePTFE stent graft
- 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
- Courses inside vascular lumen; redirects blood flow through device rather than native vessel
- Balloon-mounted: Externally mounted on percutaneous transluminal angioplasty (PTA) balloon
- Vascular stent: Catheter-mounted metallic intravascular prosthesis
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
