Technology Insight Report Coronary Stents

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Transcript of Technology Insight Report Coronary Stents

  • 1. Technology Insight Report Coronary Stents Cardiology has come a long way over the decades with huge advances having been made in areas such as invasive surgery and interventionalcardiology.Asaresultcardiacpatientshavehadthe option of undergoing preventive measures against what could otherwise result in serious complications with angioplasty. In this sphere of invasive surgery, the Coronary Stent has been one of the most significant innovations. Little over 20 years on and advances in the coronary stent in terms of material research and coatings still continues. The patent filings related to innovations around the coronary stent can reveal some great insights into this breakthroughinmedicine. Disclaimer:Thisreportshouldnotbeconstruedasbusinessadviceandtheinsightsarenottobeusedasbasisforinvestmentorbusinessdecisionofanykindwithoutyourownresearchandvalidation.GridlogicsTechnologiesPvt.Ltd.disclaimsallwarranties,whetherexpress,impliedorstatutory,ofreliability,accuracyorcompletenessofresults,withregardstotheinformationcontainedinthisreport. 2010 Gridlogics. All Rights Reserved. Patent iNSIGHT Pro is a trademark of Gridlogics Technologies Pvt. Ltd.
  • 2. Overview Introduction to the Coronary Stent AngioplastyProcedureA stent isa wire metal mesh tube usedto prop open an artery during Percutaneoustransluminalcoronaryangioplasty. The stent is collapsed to a small diameter and put over a angioplasty(PTCA),usuallysimplyballooncatheter.Itsthenmovedintotheareaoftheblockage.Whenthe calledangioplasty,involvesopeningballoonisinflated,thestentexpands,locksinplaceandformsascaffold. theblockedartery.This holds the artery open. The stent stays in the artery permanently,holds it open, improves blood flow to the heart muscle and relieves Atypicalangioplastyproceduresymptoms(usuallychestpain).Withinafewweeksofthetimethestent followsthefollowingsteps:was placed, the inside lining of the artery (the endothelium) grows overthemetalsurfaceofthestent. Thesurgeonthreadsa narrowcatheter(atube)Stentsareuseddependingoncertainfeaturesofthearteryblockage.This containingafiberoptic cameradirectlytotheincludes the size of the artery and where the blockage is.Stenting is a blockedvessel.fairlycommonprocedure;infact,over70percentofcoronaryangioplasty Thephysicianopenstheproceduresalsoincludestenting. blockedvesselusingballoon angioplasty,inwhichtheSource: http://www.americanheart.org/presenter.jhtml?identifier=4721 surgeonpassesatiny deflatedballoonthroughA Brief History thecathetertothevessel.From the time of the initial percutaneous balloon angioplasty, it was Theballoonisinflatedtotheorized thatdevices couldbeplaced inside thearteriesasscaffoldsto compresstheplaqueagainstkeep them open after a successful balloon angioplasty. This did not thewallsoftheartery, flatteningitoutsothatbecome a reality in the cardiac realm until the first intracoronary stents bloodcanonceagainflowwere successfully deployed in coronary arteries in 1986. The first stents throughthebloodvesselusedwereselfexpandingWallstents.Theuseofintracoronarystentswas freely.quicklyidentifiedasamethodtotreatsomecomplicationsduetoPTCA, Inordertokeepthearteryandtheirusecandecreasetheincidenceofemergencybypasssurgeryfor openafterwards,surgeonsacutecomplicationspostballoonangioplasty. nowmostoftenemploya devicecalledacoronaryIt was quickly realized that restenosis rates were significantly lower in stent,whichisanindividualswhoreceivedanintracoronarystentwhencomparedtothose expandablemetalmeshwhounderwentjustballoonangioplasty.Adamperontheimmediateuse tubethatisimplanted duringangioplastyattheof intracoronary stents was subacute thrombosis. Subacute thrombosis siteoftheblockage.(Astentrates with intracoronary stents proved to be about 3.7 percent, higher maybeusedastheinitialthan the rates seen after balloon angioplasty. Postprocedure bleeding openingdevice,insomewasalsoanissue,duetotheintensecombinationofanticoagulationand cases,insteadofballoonantiplateletagentsusedtopreventstentthrombosis. angioplasty.Itisnotyet clearifthisapproachisStent technology improved rapidly, and in 1989 the PalmazSchatz significantlymorebeneficialballoonexpandableintracoronarystentwasdeveloped.Initialresultswith thanPTCAplusoptionalthe PalmazSchatz stents were excellent when compared to balloon stenting.)angioplasty, with a significantly lower incidence of abrupt closure andperiprocedureheartattack.Laterestenosisrateswith 2010 Gridlogics. All Rights Reserved. Patent iNSIGHT Pro is a trademark of Gridlogics Technologies Pvt. Ltd.
  • 3. PalmazSchatz stents were also significantly improved when comparedwith balloon angioplasty. However, mortality rates were unchangedcomparedtoballoonangioplasty.Whiletheratesofsubacutethrombosisandbleedingcomplicationsassociatedwithstentplacementwerehigh,by1999nearly85%ofallPCIproceduresincludedintracoronarystenting.Inrecognitionofthefocusedtrainingrequiredbycardiologiststoperformpercutaneous coronary interventions and the rapid progression in thefield of percutaneous coronary interventions, specialized fellowship traininginthefieldofInterventionalCardiologywasinstitutedin1999. Onceinplace,thestentSource: pushesagainstthewallofhttp://en.wikipedia.org/wiki/History_of_invasive_and_interventional_cardiology thearterytokeepitopen. Complicationsoccurinabout10%of patients(about80%withinthefirst day).Inonereportof53European andCanadianmedicalcenters,the mortalityratefromallcausesfour yearsafterPTCAwas4.1%Outcomes arebetterinhospitalsettingswith