Stenting for small coronary vessels: a contestable winner.

Stents were initially used to manage or prevent acute vessel closure after percutaneous transluminal coronary angioplasty (PTCA). The first direct randomized comparison with respect to restenosis showed the superiority of stenting to PTCA for de novo lesions situated in native vessels 3 mm or larger (1,2). In these trials, stenting was associated with a 25% to 30% reduction of restenosis as compared to PTCA (1,2). This represented the first of a series of battles won by stenting regarding restenosis. Trials that followed showed better results after stenting than after PTCA for bypass graft lesions (3), lesions situated in the proximal left anterior descending coronary artery (4), restenotic lesions (5), chronic occlusions (6) and in patients with acute myocardial infarction (7). Accordingly, stent placement was unanimously indicated for the treatment of de novo or restenotic lesions situated in large vessels ( 3 mm in size).