Coronary stent implantation: a panacea for the interventional cardiologist?

Since the introduction of balloon angioplasty in 1977 by Andreas Grüntzig, the technique has gained widespread acceptance. The popularity of balloon angioplasty lies in the simplicity, safety and relative patient friendliness of this technique for treating coronary obstructions. Many other devices (laser, atherectomy, suction, ultrasound etc.) have been introduced, most using balloon angioplasty as a platform; however, none has gained a definitive place in interventional cardiology. Balloon angioplasty is effective in the majority of cases, but suffers from an often unpredictable unfavourable immediate outcome, (as a result of acute vessel closure (<5%), and an unfavourable late outcome, a 6 month restenosis rate, which ranges from 20% (large vessels, short lesions) to 60% in unfavourable lesions (complicated, long calcific lesions in small vessels)). Coronary stent implantation has effectively overcome some of the inherent problems of balloon angioplasty by reducing the rate of procedural complications and by decreasing the risk of restenosis. The basic function of the stent is simple and straightforward: enlargement of the coronary lumen by scaffolding the vessel wall; tagging of intimal flaps between the stent and vessel wall and sealing of dissections, both of which are the result of balloon angioplasty barotrauma. Coronary stenting has been shown to be successful in more than 95% of cases in both elective stable patients and in patients with acute coronary syndromes. The two predominant indications for intracoronary stenting are: (1) the need for an effective bail-out procedure for (threatening) acute vessel closure or optimalization of suboptimal balloon angioplasty, (2) as an antirestenosis device. The new third and fourth generation stents are easily and rapidly delivered and safe to use. The availability of balloon angioplasty and intracoronary stent implantation has made percutaneous coronary intervention a rapid, safe and predictable