Evolution of drug-eluting coronary stents: a back- and-forth journey from the bench to bedside

Johny Nicolas, Carlo Andrea Pivato, Mauro Chiarito, Frans Beerkens, Davide Cao, Roxana Mehran

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents (BMSs) effectively prevented abrupt vessel closure but were limited by in-stent restenosis (ISR) 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 BMSs as it mitigated the risk of ISR. 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.

Original languageEnglish
Pages (from-to)631-646
Number of pages16
JournalCardiovascular Research
Issue number3
StatePublished - 1 Mar 2023


  • Coronary artery disease
  • Drug-eluting stents
  • In-stent restenosis
  • Ischaemic heart disease
  • Percutaneous coronary intervention
  • Stent thrombosis


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