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The Intravascular Stent: A Concept in Evolution

  • J. C. Palmaz
Conference paper

Zusammenfassung

Intravascular stents are used in general, as a means to mechanically solve the most common problems of percutaneous balloon angioplasty: elastic recoil and intimai dissection. The fact that intravascular stents become embedded in the arterial wall by tissue growth weeks to months following placement was first reported by Charles Dotter in 1969 [2]. This favorable outcome occurs consistently with any stent design provided it has a reasonably low metal surface and does not obstruct flow. Endothelium grows over the fibrin coated metal surface until a continuous endothelial layer covers the stent surface, in days to weeks. Endothelium renders the thrombo-genic metal surface protected from thrombus deposition, which is likely to form with slow or turbulent flow. This is an important advantage of intravascular stenting over surgically implanted prosthetic bypass conduits which never endothelialize in patients, except for a few millimeters beyond the anastomoses. However, early stent failure may occur in situations of slow or turbulent flow, which compounds the thrombogenicity of the stent material. This is a definite risk before endothelization is complete. Understanding the series of events surrounding stent placement helps prevent stent failure. The following is a point-by-point discussion of these events.

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References

  1. 1.
    Dichek DA, Neville RF, Zwiebel JA, Freeman SM, Leon MB, Anderson WF (1989) Seeding of intravascular stents with genetically engineered endothelial cells. Circulation 80:1347–1353PubMedCrossRefGoogle Scholar
  2. 2.
    Dotter CT (1969) Transluminally placed coil springs and arterial tube grafts: long-term patency in the canine popliteal artery. Invest Radiol 4:329–332PubMedCrossRefGoogle Scholar
  3. 3.
    Noeldge G, Richter GM, Siegestetter V, Garcia O, Palmaz JC (1990) Tierexperimentelle Untersuchungen über den Einfluß der Flußrestriktion auf die Thrombogenität des Palmaz Stentes mittels 111-Indium-markierter Thrombozyten. ROFO 152:264–270CrossRefGoogle Scholar
  4. 4.
    Palmaz JC (1988) Balloon-expandable intravascular stent. AJR 150:1263–1269PubMedGoogle Scholar
  5. 5.
    Palmaz JC, Tio FO, Schatz RA, Alvarado R, Rees C, Garcia O (1988) Early endothelisation of balloon-expandable stents: experimental observations. J Intervent Radiol 3:119–124Google Scholar
  6. 6.
    Palmaz JC, Garcia O, Kopp DT, et al (1989) Balloon-expandable intraarterial stents: Effect of antithrombotic medication on thrombus formation. In: Zeitler E (ed) Pros and cons in PTA and auxiliary methods. Springer, Berlin Heidelberg New YorkGoogle Scholar
  7. 7.
    Palmaz JC, Parodi JC, Barone HD, Garcia O, Tio FO, Rivera F, Clem M (1990) Transluminal bypass of experimental abdominal aortic aneurysm. (RSNA 1990 meeting, Chicago/IL)Google Scholar
  8. 8.
    Parodi JC, Palmaz JC, Barone HD (1991) Transluminal aneurysm bypass. Experimental observations and prehminary clinical experience. (Arizona Heart Institute 1991 meeting, Phoenix/AZ)Google Scholar
  9. 9.
    Rodgers GP, Minor ST, Robinson K (1990) Adjuvant therapy for intracoronary stents. Investigations in atherosclerotic swine. Circulation 82:560–569PubMedCrossRefGoogle Scholar
  10. 10.
    Roeren T, Palmaz JC, Garcia O, Rees CR, Tio FO (1989) Percutaneous vascular grafting with a coated stent. (RSNA 1989 meeting, Chicago/IL)Google Scholar
  11. 11.
    Sauvage LR (1983) Externally supported, noncrimped external velour, weft-knitted Dacron prostheses for axillofemoral, femoropopliteal, and femorotibial bypass. In: Wright CB, Hosson RW, Hiratzka LF, Lynch TB (eds) Vascular grafting: clinical applications and techniques. Wright, Boston, pp 158–186Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • J. C. Palmaz

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