Genous™ endothelial progenitor cell-capturing stent system: a novel stent technology

Drug-eluting stents have been demonstrated to significantly reduce clinical and angiographic restenosis in patients with coronary artery disease compared with bare-metal stents. Intuitively, however, a prohealing approach for the prevention of in-stent restenosis by promoting accelerated re-endothelialization is favored over the aggressive pharmacologic cytotoxic and cytostatic approach of the drug-eluting stents. The endothelial progenitor cell-capturing stent attracts circulating CD43(+) progenitor cells that bind to the stent surface and differentiate into a functional endothelial layer. It is theorized that the accelerated establishment of the endothelial layer covering the stent struts will reduce the risk of neointimal hyperplasia and smooth muscle cell proliferation. The safety and efficacy have been demonstrated in the nonrandomized Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth (HEALING) studies, and the device received a CE mark in 2005. This article reviews the realization of the endothelial progenitor cell-capturing stent, its relevance compared with other stent types, current evidence on clinical performance, and future perspectives. At present, the larger randomized Tri-stent Adjudication Study (TRIAS) that is ongoing will directly compare the clinical usefulness of this new endothelial progenitor cell-capturing stent with bare-metal stents and drug-eluting stents.