The story of ‘STENT’: From noun to verb

STENT….STENT…….STENT….. I heard this 5-letter word even before I became fellow in cardiology and now hearing almost daily from patients, relatives, and non-cardiology colleagues. What is the meaning of stent or from where this word has been originated? Is it a noun or verb and where it exactly fits in English literature? These all questions have prompted me to know more about stent, probably the most frequently used word in cardiology practice.

The English medical dictionary meaning of a stent is a plastic resinous compound used for making dental impressions and medical molds which is used for anchoring skin grafts and for supporting body parts and cavities during grafting of vessels and tubes of the body during surgical anastomosis.1, 2 According to Oxford English Dictionary Word and Language, the word stent has already been in use since 14th century. As a noun, it was used as “stake for stretching out fishing nets upon a river” and as verb “stretching out sails, curtains, or fishing nets”.³ According to Webster's dictionary, the word stent is a dialectical form of Scottish word ‘stint’ or ‘stynt’ meaning ‘to limit’ or ‘restrain’.⁴ But most of the etymologists believe that the word stent in medicine originated from dentistry and acknowledge the contribution of Charles Thomas Stent, a London dentist for the development of the malleable plastic dental compound known as Stent's mass and is the current acceptable origin of the word in clinical practice.⁵

Charles Thomas Stent born on 17th October 1805 in Brighton, England was the 6th son of William and Hannah Stent. He was well acclaimed for his work on improving and modifying the denture material gutta-percha, the latex of a Malayan tree found in South East Asia region. This material was used in making furniture and because of its good insulation properties was also used for telegraph cables, e.g. for insulating the first transatlantic undersea cable. In dentistry, it was then used to fill dental cavities in the root of tooth for dental impression after endodontic therapy but because of its tendency to distort after removal and shrink on cooling, the material was unsatisfactory. Charles Thomas Stent modified this gutta-percha by adding stearic acid obtained from animal fat increasing its stability and plasticity and added talc as filler, which later was known as Stent's compound. He published his work (probably the only known) in Dental Review in 1859 where he states “I used the improved white plastic compound lately introduced by me to the Profession, which sets in the mouth in a minute or two, so that it can be removed without injury to the impression.”.⁶ He with his two dentist sons Charles Robert Osborn Stent (1845–1901) and Arthur Howard Osborn Stent (1859–1900) manufactured this compound commercially, by a firm located in central London named C.R. and A. Stent. After the death of Charles Thomas Stent in 1885, this compound was marketed by Claudius Ash and Sons, London and later after death of both of his sons in 1901, all rights to manufacture and marketing was with this new company keeping the name as Stent's compound because of its popularity.⁷

The use of Stent's compound from dentistry to surgery as surgical tool can be traced way back during the First World War where soldiers in trenches suffered multiple facial injuries. Johannes Fredericus Esser (1877–1946), a Dutch plastic surgeon, used sterilized Stent's compound for stabilizing the skin grafts which he called as Stent's mold.⁸ But the first time use of Dr Stent's name as noun was probably by an English army surgeon in his book, Plastic Surgery of the Face where he writes “The dental composition for this purpose is that put forward by Stent and a mold composed of it is known as a ‘Stent’.”.⁹ In the second decade of the twentieth century, the word Stent was probably used starting with a lower case “s” and used from a proper noun to adjective and to a common noun.¹⁰ Later, the word stenting was being frequently used for fixation of skin graft with Stent's compound even after the compound was replaced with other better options.¹¹ In the mid and later half of 20th century, the word stent was also used in surgery as well as in urology practice as a supporting device.12, 13

In cardiovascular medicine, the first reference for the use of the word stent was not in coronary intervention but by Weldon et al. in 1966, for the use of prosthetic stented aortic homograft in mitral valve replacement.¹⁴ In their article, the meaning of the stent was in the same sense as was used in surgical practice, i.e. as a supporting prosthesis or a kind of non-biological support used to give shape to biological tissue.¹⁵ But the credit for which we use this word in our day-to-day clinical practice goes to Charles Dotter, the father of interventional radiology but he used the terminology ‘endarterial tube grafts’ rather than ‘stent’.¹⁶ In print, the word stent for this endovascular device was used for the first time by Dotter and his colleagues in their article published in Radiology journal 1983 titled “Transluminal expandable nitinol coil stent grafting: preliminary report” although in peripheral arteries.¹⁷ In coronaries, the stent was used for the first time by Jacques Puel in 1986 and referred it as endo-protheses coronariennes autoexpansives.¹⁸ The application of this technology of endoluminal stenting in coronary and peripheral artery disease was put into real world clinical practice by Ulrich Sigwart, although he denied the origin of the word Stent after the Charles Stent which most of the etymologists believe.¹⁹ Also as endovascular prosthesis, the word stent was used in cardiology practice more often as a noun rather than as verb (stenting). While submitting the landmark article on human stenting in 1986, the New England Journal of Medicine has persuaded the author Ulhrich C Sigwart to drop the word “stenting” and to use instead “Stent” but today stenting (actually should have been Dottering…!) is an acceptable word and frequently used as a verb.20, 21

This story of stent, which started as proper noun to an adjective to a common noun and finally as a verb to describe an action, seems likely to be originated from the dentist Charles Thomas Stent, although the other obsolete English and Scottish meaning may also be there. We do not know whether the family surname Stent might have been originated from the original Scottish or an Oxford English meaning but if it is there, then both the alternatives are correct. Today, the word stent is now generic and the greatest accolade by medical fraternity to the inventor Charles Stent is given by dropping capital “S” and using the lowercase “s” in the word stent, although inadvertently.

Conflicts of interest

The author has none to declare.