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(Circulation. 1996;94:1494-1495.)
© 1996 American Heart Association, Inc.

Articles

Polymer Coatings for Stents

Can We Judge a Stent by Its Cover?

Tim A. Fischell, MD

the Heart Institute at Borgess Medical Center, Kalamazoo, Mich.

Correspondence to Tim A. Fischell, MD, Director of Cardiovascular Research, Heart Institute at Borgess, 1722 Shaffer St, Kalamazoo, MI 49001.

Key Words: Editorials • stents • biocompatibility • polymers

	Introduction

 
The article by van der Giessen et al¹ in this issue of Circulation provides an important perspective on the challenges associated with the development of a truly biocompatible polymeric stent coating.

A number of investigators have worked diligently over the past several years to explore the feasibility of a completely bioabsorbable stent.² The impetus for this approach was the perception that the long-term implantation of metallic stents might provide a chronic inflammatory stimulus and/or lead to medial atrophy with aneurysm formation that could negate the immediate- and intermediate-term (6 months) advantages of stenting compared with the use of balloon angioplasty in the coronary circulation.^{3 4} However, recent studies have suggested that concerns about "late" restenosis and aneurysm formation with metallic stents in atherosclerotic human coronary arteries are likely unfounded.⁵ The excellent long-term biocompatibility of stainless steel stents, combined with the substantive difficulties in developing a polymeric stent with a high-performance delivery system, radiopacity, and competitive structural characteristics (eg, radial hoop strength) have led previously enthusiastic polymer stent proponents to focus their efforts on developing biocompatible polymeric coatings for metal stents. Such a hybrid device (metal backbone plus polymer coating) would provide the mechanical advantages of stenting, including reduction in early elastic recoil and the elimination of unfavorable late remodeling, and at the same time provide a platform for local drug delivery to decrease stent thrombogenicity and/or neointimal hyperplasia.

Although appealing in concept, the potential difficulties in the successful development of a biocompatible hybrid (polymer/metal) stent are highlighted by the present study. . . . [Full Text of this Article]

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