History of development and comparative evaluation of modern stents for coronary arteries

Operations of myocardial revascularization include aorta-coronary or mammarocoronary bypassing and stenting of coronary arteries. Currently, coronary stenting is the most common method of revascularization, but during the operation of this method, the incidence of late complications, such as restenoses and late coronary thrombosis, has increased. The causes of these complications depend on a number of factors, including the type of stent. While vessel wall injury correlated with restenosis in the bare metal stents (BMS) era, its impact has been minimised by the use of drug eluting stents (DES), which is likely related to the use of powerful antiproliferatives with prolonged release kinetics which profoundly inhibit the reparative response to arterial injury. However, at the same time, vessel injury secondary to drug toxicity or inflammation caused by polymer is observed following DES implantation. In the clinical practice, there is a huge variety of types and models of stents, which have different indications and contraindications for use. An important factor influencing the risk of developing late complications is neointimal vascular healing, which can be assessed using various methods of intravascular imaging, such as optical coherent tomography. The purpose of this literature review, describing the evolution of coronary stents, is to systematize the main research results on the use of various stents platforms. In addition, the review presents the modern methods of evaluating the proliferation neontimy, and introduces the concept of healing index (healing score), reflects the process of vascular healing and influencing the characteristics and duration of dual antiplatelet therapy.