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Advances in stent technology
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Smriti Saraf, Paul Bhamra-Ariza
Zotarolimus (formerly known as ABT-578) is a synthesised rapamycin analogue developed specifically for intravascular stents.48 The first zotarolimus-eluting stent (E-ZES, Endeavor, Medtronic Inc., Santa Rosa, CA, USA) used a polymer consisting of a phospholipid portion, that mimics the outer membrane of red blood cells for biocompatibility, and a lauryl methacrylate (LMA monomer), that provides a hydrophobic region to confer stability and adhesion to the stent surface.49 Due to concerns over higher rates of late lumen loss with E-ZES when compared to first-generation DES,50,51 refinements to the E-ZES included a new biocompatible polymer called a BioLinx polymer. The Endeavor Resolute (R-ZES, Medtronic Inc., Santa Rosa, CA, USA) shares the same CoCr alloy platform as the E-ZES. However the newer polymer led to better drug-release kinetics; E-ZES elutes the zotarolimus in 1 week, whereas the R-ZES takes 60 days to elute 85% of the zotarolimus and 180 days to elute it completely.52 E-ZES have been shown to be non-inferior to PES in the short term,51 but in the long-term improved rates of cardiac death, MI and very late ST have been demonstrated in patients treated with E-ZES.53 E-ZES and SES have been shown to have better long term safety over PES54 and comparable rates of definite or probable ST at 3 years (Table 31.1).55
A technology evaluation of the Onyx Frontier drug-eluting stent
Published in Expert Opinion on Drug Delivery, 2023
Pier Pasquale Leone, Manaf Assafin, Andrea Scotti, Maday Gonzalez, Andrea Mignatti, Kathryn Dawson, Judah Rauch, Asma Khaliq, Dimitrios Bliagos, Azeem Latib
Zotarolimus is a tetrazole-containing macrocyclic immunosuppressant with extremely low water solubility; its molecular formula is C52H79N5O12 and its molecular weight is 966.2 Da. Compared to its analog sirolimus, which is also an inhibitor of mTOR, zotarolimus is more lipophilic, which improves its ability to cross cell membranes and reach targeted cells [31]. In order to highlight relevant features of Onyx Frontier ZES and further examine its role in the treatment of CAD, it is relevant to first to outline the progressive evolution of ZES, starting from its progenitor [32]. Indeed, numerous iterations followed since the approval of the Endeavor stent in 2005, i.e. Endeavor Resolute, Resolute Integrity, Resolute Onyx, and Onyx Frontier (Table 2).
Drug-eluting stents for the treatment of coronary artery disease: A review of recent advances
Published in Expert Opinion on Drug Delivery, 2022
Along with these two initial drugs, a variety of immunosuppressive and anti-proliferative drugs were tested, and to date, “limus’ type of drugs has shown effectiveness. Everolimus is a hydroxyethyl derivative of sirolimus that works similarly by inhibiting mTOR. Everolimus-eluting stents have been shown to be superior, both in efficacy and safety, compared to first-generation DES [23]. Biolimus A9, a semi-synthetic analog of sirolimus, is similar in potency to sirolimus but is 10 times more lipophilic [24]. Zotarolimus is a semi-synthetic derivative of sirolimus, designed specifically for use in stents. It has a shorter in vivo half-life than sirolimus but the same high-affinity binding to the immunophilin FKBP12, along with comparable inhibition of T-cell proliferation in vitro. Zotarolimus-eluting stents have been shown to be non-inferior to everolimus-eluting stents [25].
The EluNIRTM Ridaforolimus Eluting Coronary Stent System
Published in Expert Review of Medical Devices, 2019
Panagiotis Savvoulidis, Gidon Perlman, Rodrigo Bagur
The EluNIR™ RES combines easy deliverability with great vessel support, coating integrity, and uniform elution of the Ridaforolimus drug. The stent has established its safety and efficacy in two randomized trials in a large number of patients compared to a world-class Zotarolimus-eluting stent. The elastomeric polymer with which the stent is coated, not only enables sustained controlled release of the drug but it is also resistant to surface damage. The polymer surface integrity may contribute to reduction in tissue inflammation and resistance to platelet adhesion. Recently, durable polymer coated stents have shown excellent results with regards to resistance of stent thrombosis compared with biodegradable polymer coated stents [26]. The EluNIR™ stent has also demonstrated favorable clinical outcomes with no late stent thrombosis events reported in the BIONICS trial [24]. More data are required regarding the performance of the EluNIR™ stent in various clinical situations, and this will be generated by further clinical trials that are being planned.