Biodegradable drug scaffolds

At present, coronary heart disease is one of the main causes of health hazards and sudden deaths among the population, and is the main cause of death among heart disease patients. New treatments and early diagnosis of coronary heart disease have helped to reduce the mortality rate from coronary heart disease. In determining the best course of treatment, a combination of therapeutic options includes lifestyle changes, standard or intensive drug therapy, and minimally invasive coronary intervention or surgical coronary artery bypass grafting. Minimally invasive coronary intervention has gone through three phases in more than 30 years since Gruentzig performed the world’s first percutaneous transluminal coronary angioplasty (PTCA) in 1977: the era of balloon dilatation alone, the era of bare-metal stenting, and the era of pharmacologic stenting. Simple balloon dilatation without permanent endovascular support leads to high restenosis rate (30-50%) due to vascular elastic retraction, thrombosis, and excessive neointimal hyperplasia; bare metal stent avoids elastic retraction and reduces restenosis rate (20-30%); drug-coated stent not only keeps the vessel open, but also releases the coated drug slowly and inhibits neointimal formation, which greatly reduces the restenosis rate (<10%); and drug-coated stent not only keeps the vessel open but also releases the coated drug slowly and inhibits neointimal formation, which greatly reduces the restenosis rate (<10%). This greatly reduces the restenosis rate (<10%). However, the era of drug-coated stents is also characterized by a number of intractable problems, which greatly affect the long-term prognosis of patients after stenting: stents, as metal supports, affect the normal systolic and diastolic activities of the vessels; in-stent restenosis is difficult to deal with; it affects the endothelial repair and leads to very late stent thrombosis; chronic inflammation due to foreign body; vasomotor mismatch between stented and non-stented sites, and the resulting risk of coronary angiomas; the risk of coronary aneurysms; the risk of stenting and non-stented stents; and the risk of coronary artery stents. coronary angioma risk; potential risk of stent fracture; and increased difficulty in performing surgical revascularization at a later date. In addition, the long-term presence of metallic implants affects the safety and efficacy of MRI and CT examinations when necessary. If the interventional therapy used for the treatment of cardiovascular obstructive diseases has already caused the "first medical damage" to the blood vessels, then the stents will cause the "second medical damage" if they remain in the body for a long time. Currently, several companies are developing a new generation of fully degradable stents. Since the new generation of stents can be completely degraded, there is no need to worry about the risk of blood clots, and it can greatly shorten the time of taking antiplatelet drugs after the operation, and at the same time, if the patient does bypass surgery next time, it will not be affected by the residual metal stents. It is believed that in the near future, fully degradable stents will become a new trend in the field of coronary intervention. The ideal design concept for the new generation of stents is that the stent mechanically supports the vessel for a period of time after the intervention and prevents restenosis with the help of the eluted drug. Afterwards, the stent is slowly degraded and completely absorbed by the tissue, and the vessel structure as well as the diastolic and contractile functions are completely restored to their natural state, thus avoiding the associated potential risks. This is what has been called the fourth revolution in coronary intervention - the fully biodegradable stent. Currently, several companies are developing fully biodegradable stents, such as Abbott (BVS), Igaki Medical (Igaki-Tamai), Biotronik (AMS), REVA Medical (REVA), Johnson & Johnson, Orbus Neich, ART, and others. Vessel Scaffold) has begun clinical studies with promising results. This fully degradable stent, which completely degrades into water and carbon dioxide within two years, has become a new and interesting development in the fourth revolution of coronary intervention.