Slide 1: Which commonly used cardiac device is named after a dentist?
Slide 2: The coronary stent!
Slide 3: A coronary stent is a tube-shaped device implanted in the coronary arteries to treat coronary artery disease. Its name originates from 19th century English dentist Charles Thomas Stent – creator of Stent’s Compound, a material used to create dental impressions.
A Dutch plastic surgeon used Stent’s Compound to stabilize skin grafts in World War 1 soldiers with facial wounds. Since then, the word has gradually come to represent an intraluminal device in medical literature.
Slide 4: Drug-eluting cardiac stents (DES) have three key components: 1. A metal scaffold of the stent itself. 2. A chemotherapeutic drug coating that prevents in-stent restenosis by inhibiting overgrowth of coronary smooth muscle. 3. A polymer that binds the drug to the stent.
Problems with any of these components can lead to issues with the stent, including in-stent restenosis and stent thrombosis.
Slide 5: In-stent restenosis. Hyperproliferative occlusion of the stent, caused by neointimal hyperplasia (overgrowth) of smooth muscle in the coronary arteries. This occurs over a longer period of time. Interesting, these patient may still present with acute coronary syndrome. This is prevented by chemotherapeutic drug coating on the stent itself, but hard to prevent medically.
Stent thrombosis. Thrombotic occlusion of the stent, caused by: lack of anti-platelet therapy, issues with stent placement, and inflammatory polymer. This typically occurs acutely and presents as an acute coronary syndrome. This is prevented by dual anti-platelet therapy.
Recently, polymer materials have become more biocompatible and thus less inflammatory, leading to lower rates of stent thrombosis. Future stent design is focused on the creation of bio-absorbable stents and polymers that will be completely absorbed within years of placement.
- Roguin A. Stent: the man and word behind the coronary metal prosthesis. Circ Cardiovasc Interv. 2011 Apr 1;4(2):206-9. PMID 21505167.
- Katz G, Harchandani B, Shah B. Drug-eluting stents: the past, present, and future. Curr Atheroscler Rep. 2015 Mar;17(3):485. PMID 25651784.
Tags: cardiology, stent, stent restenosis, stent thrombosis, trivia tuesday