The implantation of coronary stents (CS), expandable tubular metallic implants, into clogged coronary arteries brought on by the underlying atherosclerotic condition. This process of revascularization is called as percutaneous coronary intervention (PCI) or coronary angioplasty with stent placement. The market for Coronary Stents was valued at $8.56 billion globally in 2021 and is anticipated to grow to $13.03 billion by 2030, reflecting a CAGR of 4.78 percent from 2021 to 2030.
Coronary dissection and vascular recoil have been eliminated because to the expandable, metallic meshwork of coronary stents, which prevents unfavorable remodelling. This activity covers the presentation, assessment, and therapy of coronary artery stenosis and emphasizes the value of a multi-disciplinary team approach for the betterment of the affected patients.
Epidemiology
About 20 percent of all deaths in the US are caused by coronary artery disease (CAD), which is the world's most common cause of morbidity and mortality. Atherosclerosis, the fundamental cause of CAD, causes plaque to build in the coronary artery lumen. Because atherosclerosis is largely asymptomatic until the advanced stages, it is impossible to estimate its exact prevalence. It begins early in childhood and progresses to developing fatty streaks. People in their fifth or sixth decade of life typically have more advanced and complex lesions. About 14 million people in the US suffer from CAD and associated consequences, the most prevalent of which is post-myocardial infarction heart failure (HF).
Acute myocardial infarctions (AMI) affect 1.5 million Americans each year; of these, 33% are fatal.
Pathophysiology
Endothelial cell dysfunction (ED), which results from the long-term presence of various cardiovascular risk factors like dyslipidemia, chronic uncontrolled hypertension that causes shear stress, and uncontrolled diabetes mellitus that cause non-enzymatic glycosylation of surface lipoproteins on endothelial cells, is the early pivotal event in atherogenesis. It is thought that ED causes dysregulation of endothelial nitric oxide synthase (ENOS), which reduces the synthesis of the vasodilator NO (nitric oxide) and increases the generation of the oxidant superoxide. This imbalance of vasoconstrictive substances (such as histamine and nitric oxide) and vasodilators compromises vascular hemostasis, which increases turbulence, shear stress, and ED.
Toxicokinetics
In-stent restenosis caused by intimal layer injury is one of the main disadvantages of BMS. The underlying process through which intimal damage causes an increase in SMC migration and proliferation in the intimal layer, ultimately leading to restenosis, is known as neo-intimal hyperplasia (NIH). Anti-restenotic medications can be locally delivered by DES, acting to prevent SMC migration and proliferation at the stent site without causing systemic drug side effects. The diffusion rate, tissue accumulation, distribution, and local vascular toxicity all affect a drug's effectiveness. Therefore, a balance between an appropriate drug dosage, administration, and low local vascular toxicity should be struck.
The amount of drug loaded, the coating thickness, the drug to polymer ratio, and the partition coefficient (PC) of the drug are some of the variables that affect the rate of diffusion. PC and diffusion rate are directly proportional.
CONCLUSION
Despite the fact that there exist numerous treatments available for those who have ischemic heart disease, the primary care physician and nurse practitioner should place a strong emphasis on prevention. Primary prevention is the most economical and clinically significant method of lowering the burden of IHD. It has been demonstrated that educating the general public about a healthy lifestyle, eating habits, and regular exercise can lower the prevalence of IHD. According to a recent study, education-based interventions may enhance the quality of life in terms of health. Clinicians and nurses should advise patients with IHD on medication compliance and lifestyle changes to lessen the influence of their risk factors on heart health.
