Which is the best type of cardiac stent: Metallic, Medicated, or Bio

absorbable?
Amogh Arun
Dr. Kiehl
Dr. Albornoz
Intern Mentor GT
Abstract

Throughout the generations, there has been a significant increase in obesity which has

resulted in a significant increase in heart disease. If humans dont change, by the next decade the

problem will get out of hand. The goal of the study was to examine which cardiac stent, Metallic,

Medicated or Bio absorbable stent, is the most easy to use for the doctors and efficient for the

patient. Using a combination of others research, the researcher tried to find the most efficient

and practical fuel stent. The results showed that bio absorbable stent are yet to become practical,

therefore as if right now the best stent is the medicated stent, but with some improvements the

bio absorbable stent could be used in the future. The results of the experiment was shown to a

chemistry class along with model designs to demonstrate to the students that change must occur.

The results of the experiment were presented in a presentation, which was very persuasive and

received much positive feedback. The results of the experiment show that with much research in

stents there are stents that are very efficient, like bio absorbable stents, and with some research

humans can not only help change the stent, but will change the lifespan of humans.

Review of Literature

Resilience is all about being able to overcome the unexpected. Sustainability is about

survival. The goal of resilience is to thrive. (Cascio) Today, one Million Americans suffer from

heart disease yearly. These people show resilience, but the goal is sustainability, and improving

cardiac stents would achieve just that. In the heart, there are three main arteries, the Left Anterior

Descending (LAD), the Circumflex (Circ) and the Right Coronary Artery (RCA). The LAD

supplies blood to the front of the heart. The Circ supplies blood to the back of the heart. And the

RCA supplies blood to the heart ventricles and the right atrium. If any of these coronary arteries

or their branches get clogged the heart losses blood flow to the respective part of the heart. This

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is horrible for the patient because it means that the cells in that area of the heart are dying by the

second and without cells, the heart cannot contract and circulate blood to the rest of the body.

Heart blockages are a problem that affect millions daily. However, until 1985, Heart blockages

meant certain death. Julio Palmaz, an intervention vascular radiologist, patented the balloon-

expandable medical stent and changed the course of cardiology forever. First, what are stents?

Stents are a small mesh tube used to expand narrowed or completely clogged arteries. In the

medical world, stent procedures are known as Coronary angioplasty. Know in most hospitals

there are two types of stents, plain metal stents and medicated stents. Both are maneuvered into

the clotted area of the heart and inflated to support prevent further clottage. The only side effect

is that both stents have a chance of reclotting, as they are foreign objects in the body. With the

use of polymer stents, the side effects could be significantly reduced, so much that a stent may

not need to be in the heart forever. Improving the material of stents is crucial to improving

patients lives after their procedures. This paper will analyze the problems with metallic,

medicated, and biodegradable stents, compare the three stents to determine the best one, and

identify improvements that can be made to each of the stents.

If it is not broken, why fix it is a common saying that is widely used to describe objects

that do the job they were designed to do and do them effectively. Metallic stents are just that.

They have been around since the creation of stent technology and have saved billions of lives.

Metallic stents, also known as first-generation stents, are made from stainless steel. They are

very effective in making sure that the unclogged artery would not collapse, which brings the

argument that metallic stents do not need to be changed. (Types of stents and their uses:

Coronary artery stents). Metallic stents are reliable and are the basis of all stent technology. They

are highly compatible to the ideal stent procedure and much information is already known about

possible complications of the procedure, mainly the reclotting of the artery, and preventions of

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these complications, mainly the use of blood thinners. In addition, metallic stents have a strong

shape, which has been effective in reducing the reclotting of the arteries, but there is little

improvement that can be made in the first-generation stents. Since the creation of the first-

generation metal stents, which were extremely thick and inflexible, the restenosis, the narrowing

of a blood vessel, was reduced further to 20 percent. (Kern, 2012) Another aspect that must be

considered is the ease of use. The cardiologist doing the procedure has many factors that must be

accounted for when doing the procedure. Metallic stents ease of use allows for the doctor to pay

more attention to the other possible complications which include finding the site of the blockage

and monitoring the patients vitals, because they are confident in the ability and flexibility of the

metallic stent. (Albornoz, 2016) Metallic stents are also currently mass reproduced because of

their long existence, so metallic stents are widely available in most places. Also, First-generation

stents are relatively cheap because of their long existence. As of 2014, the price for bare metal

stents is at its cheapest 450 dollars and at max 1,050 dollars. This reduced price makes the

overall cost of the procedure decrease reducing the monetary burden on the patients families.

Along with the reduced cost of the procedure, the recovery time from a metallic stent procedure

is much less than alternative stents. This recovery time usually includes taking blood thinner for

a year, and being discharged from the hospital fairly quickly. In addition, the procedure time

itself is less because the doctors are highly trained with the first-generation stent, so placement of

the stent is very efficient and minimally invasive. (Albornoz, 2016) However, the question arise

whether the reduced cost of the stent justifies the increased danger that the patient is put into by

the application of the first-generation stent. The chance of reclotting is, at best, around twenty

percent, meaning that one in every five people will have to see the doctor within 6 months.

(Types of stents and their uses: Coronary artery stents) The limited possibility of improvements

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is a major obstacle in improving the metallic stent, because the material of the metallic stent,

stainless steel is not accepted by the patients bodies. First-generation stents have paved the way

for improving the lives of millions but the further complications that metallic stents cause

patients, specifically the re-stenting around metallic stents causes more problems for the patient,

monetarily and physically, and the doctor nullifying the vast benefits. Metallic stents led the

development of improved medicated stents. These stents are fortified with polymers, these

polymers make the stent more widely accepted by the host body.
The medicated stent, also known as the drug-eluting stent, was created as an

improvement on the metallic, first-generation stent. The stent is the same structure as the first-

generation stent but the stainless steel frame is coated with the TiNo polymer. (Lotan, n.d.) This

prevents the further reclotting of the cardiac arteries because of the stents improved

compatibility with the patient. In fact, the TiNo polymer is determined to be the safest polymer to

coat the stent with in the patient. This leads to the lack of a need for improvements to the

medicated stents. (Kolansky, n.d.) The success rate of the procedure increased significantly, as

the restenosis rate decreased to the single digits, specifically less that ten percent. (Kern, 2012) In

addition to patient safety, the cardiologist specialized in stent technology have been trained to

use the medicated stents effectively. Medicated stents are reliable and are the basis of further

improvements in stent technology. They are highly compatible with the ideal stent procedure and

much information is already known about possible complications of the procedure, mainly the

reclotting of the artery, and preventions of these complications, mainly the use of blood thinners.

This allows for less doctor related complications throughout the procedure. (Albornoz, 2016)

The drug-eluting stent has been on the market for a long period of time because of its practicality

and ease of use. The mass production of this stent has reduced the cost to a relatively low price,

as of 2014, of 1,419 dollars on average, with a high of 2,070 and low of 1,150. (Adams, n.d.)

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This allows for the widespread use of the upgraded medicated stent, but may cause problems in

third world countries where the cost of the stent is too much. So, the ethical question arises, is

the improved stent better for the world or just for the countries that have the money and the

infrastructure to allow the widespread distribution of the stent. This problem is furthered by the

problems with restenosis that still exist. Because the polymer is not a completely natural one,

there are still cases where the patients arteries will reclog despite the polymer coated stent. This

reclotting requires more and more stents which could lead to a more invasive heart bypass graft

which would hurt patient monetarily and physically because the graft is a highly invasive

procedure. In addition, the medicated stents allow for the improvement in the effectiveness of the

procedure, the patient is required to take blood thinners for a longer period of time, which leads

to a greater window of problems that could arise for the patients, if they do not follow the

cardiologists diagnosis. Medicated stents allow for more human error, which means more

complications for the doctors. Medicated stent overall have had a huge impact on the

development of a better stent for society and has lead researchers on the right path to creating the

most ideal stent, a stent that dissolves after a couple of years in the patient. These improvements

have saved presidents lives and have had many important contributions to society. (Mandrola,

2013) Ultimately, medicated stents have bettered the lives of millions, but has only been a

stepping stone to the perfect stent, the bio absorbable stent.

The future of stent technology is without a doubt biodegradable stents. The bioabsorbable

stent is made of a plastic polymer which unclogs the arteries of the heart and stays in the heart

for two years. After 24 months the stent slowly starts to disappear as it degrades, leaving the

artery open, but with no trace of the stent that held the artery open. The waste product of the

biodegradable stent is H20, the source of life. Because the stents leaves no trace after 2 years in

the artery, there is reduced thrombosis, reduced scarring of tissue. (Lusher, 2007). However,

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despite the many benefits that the new stent technology has, there are many problems with the

placement of the heart stent. The polymer which allows for the stent to be biodegradable is not

easily seen under the x-ray, so the cardiologist is forced to base the placement of the stent in the

right place solely on two markers on the end of the stent which are seen on the xray machine.

Placing the stent in the right position requires skills and training, both of which are costly and are

hard obstacles to overcome. In addition, all the research that has been put into the medicated

stents has gotten rid of all the research that has been done over the last 7 years. (Albornoz, 2016).

This increases the chances of mistake because of the new procedure, putting the patient in more

danger. Along with that, the stent is not mass produced because of the lack of efficient means of

creating the stents, this leads to increased costs and more pressure on patients to pay the higher

price to get the better stent. The biodegradable stent is the future of the cardiology field of stents,

but there are many obstacle that must be overcome because they can be an integral part of the

medical community. (Kern, 2012)

What is a perfect stent? A perfect stent can be characterized as one that everyone has

access to, one that is compatible with every human being on the planet, and is easy for

cardiologist to place in the patient. Unfortunately the perfect stent does not exist, and there is still

much improvement before the perfect stent can be made. The metallic stent is the original stent.

It is reliable, easy to use, and relatively cheap. However, the argument arises about the tradeoff

between efficiency and effectiveness. The metallic stent is cost efficient as well as easy to use,

but the flaws of the stent put the patient in danger because it is not fully compatible with the

body. In order to improve the problems with the metallic stent, the medicated stent can be

considered. With increase compatibility with the human body, the patient is exposed to less

dangerous situations. The medicated stent is similar to the metallic stent with its ease of

application, but the cost is increased. This increased cost can be a major problem for the

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accessibility of the stents to lower socioeconomic class. However, the argument once again arises

between patient health and cost. The medicated stent is an improved stent that has changes the

field of cardiology, but despite the polymers on the stainless steel frame, the stent has a

percentage of patients that still have compatibility issues. This issue is fixed by the biodegradable

stent. This stent is the future of stent technology. The stent has the ability to unclog arteries and

disappear in two to three years. This prevent future damage to the patient. However, the stent is

so early in development that many problems arise. Specifically, the stents lack of ease of

application. In addition, the cost is relatively high, leading to financial problems. The main

problem with the stent technologies is balancing effectiveness with cost. For patients with

diseases that affect the patients abilities to take blood thinners, it is necessary to have regular

stents, which require minimal use of blood thinners. However, for those who are healthy

individuals, people who usually get the disease through genetics, the biodegradable stent would

make more sense as the chances of reclogging is significantly less in these individuals (Inherited

cardiac conditions (genetic disorders), n.d.). Overall, biodegradable stents are the future of stent

technology. However, the technology is currently limited because of its flexibility and its lack of

sight under the x-ray machine. Improvements in these areas will significantly increase the

application of the stent. But, with the resources that are currently available, the medicated stent is

the best stent because it balances patient safety and cost, specifically in its ease of application

and lack of future problems in the arteries. With government involvement, stents can be more

accessible to a larger group of individuals. This increase accessibility allows for the benefits of

stent technology to spread to anyone in need.

The heart is an important organ in the proper functions of the body. The heart is like the

engine of the body. Fixing arteries in the heart is only the start of the fix to a bigger problem, just

like fixing a wire in the engine is only the start. An engine of a car must be properly maintained

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or problems will continue. Similarly, in order to fix heart problems, the heart must be maintained

properly. Stents will always play a major factor in human life. Most humans refuse to fix their

diets and change their lifestyles. The only way to prevent heart disease in the medical industry is

by changing everyone in this worlds lifestyles. The world together must do this by creating more

beneficial habits. The future lies in our hands, it is our duty as humans to keep our bodies

healthy, but with improvements in stent technology, more people with genetic problems will still

be allowed to live normal lives. As Les Brown stated Life has no limitations, except the ones

you make. Humans have the ability to change their fate by simply choosing a healthier lifestyle

which includes improved diets, increased exercise, and less reliance on medications.

Improvements in all of those areas will allow less limitations on life. However, if humans keep

on the same track, they will make millions of limitations on their own lives.

Research Methods and Data Collection

The researchers question that was attempted to solve in this research was which cardiac

stent is the best, Hydrogen, Electric or Solar. The hypothesis was that biological stents will be the

best and most practical cardiac stent. Through the research, the researcher used many articles

which all stated that biological stents required much improvement in order for the cardiac stent

to be a viable for common use. Due to lack of funding, the researcher was able to only Meta-

analyze the research done by Tullio Palmerini and her colleagues for the metallic stent data

collection. This Journal exclusively analyzes the effect of the metallic stent on thrombosis in the

arteries of the heart. They concluded that as early as 30 days into the trials they saw that the

patients with the metallic stent exhibited more thrombosis that the patient with the medicated

stent, specifically the stent covered with CoCr. For the drug-eluting data collection, the

researcher used a combination of Tullio Palmerini and her colleagues and Lusher and his

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colleagues research. Tullio Palmerini came to the conclusion that the drug-eluting stent was

much better due the released drug, which allowed for the thrombosis to be significantly reduced.

Lusher and his colleagues came to a similar conclusion but focused their research on the specific

problems that the metallic stent has, which include the problems with a longer stent, congestive

heart failure, and prothrobogenic state, which includes certain cancers. The only issue is that

medicated stent had problems after a certain amount of time, but was much rarer than with

metallic stent patients. The Journal written by Prof Raimund Erbel and his colleagues addresses a

targeted experimentation, highlighting the ideology that certain stents are better for certain

people with previous conditions. Therefore, they had a non-randomized trial. Lastly for the bio

absorbable stent data collection, the researcher used Ormiston and Serruys research. They

conclude that the thrombosis reduced but there were many problems that affected the data. This

included procedure related like stent length, or patient related, like diabetes or a low ejection

fraction. The journal establishes the many problems with stents while also expanding on the

many benefits that stents have in the body, specifically biodegradable stents. The journal also

expands on the comparisons between the metallic stents and the biodegradable stents and support

it with data from their experiments. They also determined the bio absorbable stent is the most

practical in the future.

Results and Data Analysis

The data collected during the analysis of the journals supports the fact that bio absorbable

stents have major problems that must be addressed before the stent can become the primary one.

Therefore the data proves that even though the medicated stents has some negative impacts on

the patient, specifically through thrombosis, the medicated stent, not as predicted, is the best

cardiac stent at the time. Specifically, the data collected from the journals shows that the

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medicated stent fixes the major problems that the patients have with metallic stents while

keeping an ease of use for doctors with busy schedules. For bio absorbable stents, the first

journal shows that the bio absorbable stents are the better type of stent to be used in humans but

the issue is that the bio absorbable stent is not easy for the doctor to place in the patient and is

quite costly. The second journal concludes that the medicated stent itself is extremely efficient in

terms of the doctors ability to place the stents in a timely fashion. Along with that, it addresses

the fact that the medicated stent is the superior stent that has limitations. The journal about

metallic stents addresses the issues that comes with metallic stents and their inferiority to the

medicated stent. The first is the fact that the stent is not readily accepted by the body, and in

general the stent is not much cheaper than the medicated stent, so it has no real benefit to the

public except for extenuating circumstances.

Discussion

The findings from this experiment has proven that the future of cardiac stents is

biological stents, but biological stents need future research. In order to initiate this change, much

research must be done, but as if now the medicated stent is the best type of cardiac stent. From

this stent much can be done but the most important step is developing the biological stent

because the stent has proven to be a viable stent for the future, but the issue is that the cost and

ease of use is not advanced enough for widespread use.

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