Los stents metálicos se desarrollaron para combatir el retroceso elástico, las complicaciones agudas y la reestenosis de la angioplastia con balón, pero crearon una nueva entidad, la restenosis intra-stent, ligada a múltiples factores. Entre ellos, las características clínicas del paciente y el tipo de lesión son inmodificables. Sin embargo, la técnica de implante y, muy particularmente, el diseño del stent han experimentado una gran transformación que ha desembocado en la nueva era de los stents recubiertos, stents liberadores de fármacos o el término que mejor los define, stents farmacoactivos. Estos nuevos stents son dispositivos muy complejos que involucran tecnología y diseño de la plataforma o stent, investigación y desarrollo en el terreno de los polímeros que actuan como transportadores y liberadores de los fármacos, y el propio fármaco que debe inhibir la proliferación neointimal. Si bien los primeros diseños, con 5 años de seguimiento clínico a sus espaldas, han mostrado una reducción significativa y sostenida de la reestenosis y las nuevas revascularizaciones frente a los stents metálicos convencionales, también han mostrado debilidades y sombras, que deben irse corrrigiendo en las próximas generaciones de stents farmacoactivos.
En esta revisión se lleva a cabo un análisis detallado de la importancia del diseño del stent, se hace una incursión breve en el mundo de los polímeros, sus tipos y su funcionamiento, y se describen los fármacos empleados en los stents farmacoactivos. Se analizan las características y los resultados clínicos y angiográficos de los stents actualmente disponibles o en fase de estudio, y se abre una ventana hacia los futuros desarrollos.
Palabras clave
Stent recubierto
Polímeros
Sirolimus
Paclitaxel
Everolimus
Zotarolimus
Biolimus A-9
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