Coronary Stents Explained: From Bare Metal to Bioresorbable Scaffolds

Coronary artery disease remains a leading cause of death worldwide, and the ability to physically open blocked arteries with minimally invasive procedures has transformed cardiac care. Understanding the tools cardiologists use — and how they work at the molecular level — matters both for clinicians managing patients and for health-conscious adults weighing treatment options.

This StatPearls review article provides a detailed technical and pharmacological overview of coronary stent technology. It traces the history from pre-stent balloon angioplasty, which was limited by arterial recoil, dissection, and restenosis from neointimal hyperplasia, through to the current generation of sophisticated implantable devices.

Four main stent types are covered: bare metal stents (BMS), drug-eluting stents (DES), bioresorbable scaffold systems (BRS), and drug-eluting balloons (DEB). Drug-eluting stents are the most widely used. They combine a metallic platform — typically cobalt-chromium or platinum-chromium — with an antiproliferative drug and a biodegradable polymer carrier. The drugs used fall into two classes: rapamycin-class agents (sirolimus, everolimus, zotarolimus) that inhibit mTOR via FKBP-12 and arrest the cell cycle at G1, and taxanes (paclitaxel) that disrupt microtubule function and arrest cells at G2. Both mechanisms suppress smooth muscle cell proliferation that would otherwise cause restenosis. Second-generation DES improved on first-generation devices through more biocompatible materials and polymers that degrade cleanly into water and carbon dioxide.

Bioresorbable scaffolds take the concept further — the entire device dissolves within months, potentially restoring normal vascular function. Drug-eluting balloons deliver drug therapy acutely without leaving a permanent implant, useful in specific anatomical scenarios.

For longevity-minded readers, the mTOR inhibition mechanism is particularly noteworthy, as rapamycin and its analogs are among the most studied anti-aging compounds. The clinical implications are significant: stent selection directly affects long-term outcomes including restenosis rates, thrombosis risk, and duration of required antiplatelet therapy.