Influence of stent design on clinical outcome

Placement of a stent in a vessel involves damage to the endothelial cells (ECs) at the site of deployment as a result of the stent's radial and shearing forces, and by the obliteration of the vessel surface by the device itself. Part of the healing of the stent by the vessel wall involves restoration of the endothelial cover by migration and proliferation of ECs from adjacent patches of endothelium that survive the placement of the device. When the migrating ECs arrive at the device boundaries, physicochemical and topographical characteristics of the prosthetic surface influence interactions between the device and the ECs. The physicochemical characteristics of the material largely influence protein binding and molecular mechanisms involved in cell migration and attachment. The topographical characteristics influence ECs by altering local rheology, and by presenting a physical obstacle to the path of migrating cells. This paper focuses on the latter effect.