15 All these developments resulted from tight collaborations between physicians and engineers with industrial and financial support around them. Many new companies were founded and later merged into larger companies. It was a bubbling and vibrant community with tight collaborations between academia, clinical institutes, and industry. After FDA approval of the Palmaz–Schatz stent, stent penetration into the market was unprecedented. Within 4 years (1994–1998), stent usage climbed from 0% to 80% of PCIs. Abrupt coronary occlusion was minimized to a reasonable percentage, and restenosis

was reduced (but not eliminated). In a recent interesting paper, Xu et al.16 studied the innovative Inhibitors,research,lifescience,medical process in coronary stent development. Their results showed the central role of physician-innovators and their small private

companies in helping create this field. Larger public companies made their contributions later in the product development time-line. The Inhibitors,research,lifescience,medical authors suggest implementing new policies in academic and clinical institutions, Inhibitors,research,lifescience,medical aimed at encouraging transformative medical device development through translational research at the early stages of technology development. THE TRIANGLE OF COLLABORATIONS BETWEEN INDUSTRY, ACADEMIA, AND PRACTICING PHYSICIANS The disrupting technology of balloon angioplasty and stenting has driven numerous competitive attempts to develop stents from different metals such as tantalum, titanium, self-expanding nitinol alloy, and even gold coated with diamond dust.17 It has been a virtual parade of large and small industry-driven initiatives, attempting to improve this disruptive technology in small additive steps. Various manufacturing

techniques Inhibitors,research,lifescience,medical involved major industries that specialized in stent-related technologies. Refining stent-balloon delivery performance and dealing with profile, flexibility, and tractability were huge challenges for this dynamic engineering world. Surface coating with inherent materials such as carbon, stable polymers, and even conjugated heparin molecules was attempted Inhibitors,research,lifescience,medical in order to achieve better tissue compatibility. However, restenosis was not reduced until the industry, sparked by combining pharmacology and biomaterials, 4-Aminobutyrate aminotransferase developed the first drug-eluting stent. The first drug-eluting stent was a standard metal stent, coated with a layer of durable CP-868596 solubility dmso polymer containing sirolimus, an anti-proliferative drug, covered by another layer of polymer to control the release of the drug over 8 weeks.18 This represented a huge disruptive technology—an optimally matched combination of a device and a drug. It was also a victory for the tight collaboration between the engineers and scientists, appropriately applied to patients by clinicians. This classic triangle of interaction between industry, academia, and practicing physicians was once again proven successful.