Stent Implantation after Ptca: an Overview

AFTER THE INTRACORONARY application of metal stents initially proposed by U. Sigward, a very aggressive anti thrombotic treatment was used. During the last years, however, the anti thrombotic treatment has been completely reevaluated. Currently, the therapy with ticlopedine and aspirin reveals excellent results with little bleeding. The current indications of stent implantation are severe dissections and impending occlusions of the coronary arteries after intracoronary interventions. These bailout applications, in many occasions, are able to keep the vessels open, to stabilize the dangerous situation, and to save bypass surgery. The second indication is insufficient dilatation result with large dissection and intracoronary flap. The third indication is given in patients with recurrent restenosis after previous dilatations. Stents have been implanted in patients with acute myocardial infarction, mechanical opening of the infarct artery, and a high risk of reocclusion. Many approaches to develop special stents, which can deliver substances to the endothelium and the dilated region, are underway. By this, the mechanisms of restenosis may be influenced. Since the first application of intracoronary balloon dilatation (PTCA) by Andreas Gruntzig, in 1977, in Zurich, Switzerland, many improvements of this technique have been achieved. The success rate of intracoronary maneuvers is 90% to 95%. Complicated coronary artery segments in multiple vessels can be reached and treated successfully. Up to now, however, the high restenosis rate after the