[Coronary angioplasty: always a stent in arteries larger than 2.5 mm? The arguments pro]

Coronary stenting has provided better results than balloon angioplasty in terms of primary success and restenosis in previous randomized studies. These studies only included short coronary lesions located in vessels larger than 3 mm. Thus, these results can not be applied to complex lesions or those located in small vessels. In the present article we summarize our points of view regarding the current indications of coronary stenting in these types of lesions, where the use of this device may be still controversial. In all these situations the results of the stent seem to be better to those previously reported with balloon angioplasty. However, there is a percentage of patients treated by balloon angioplasty in whom a good immediate and long-term result can be obtained. The identification of patients with optimal result after balloon angioplasty need a postprocedure study of coronary flow reserve. The comparison of optimal balloon angioplasty (by angiographic and coronary flow reserve criteria) and stent, is the main objective of 2 studies that are currently under process. We will have to wait the results of these clinical trials to answer to the question if the implant of stents in all kind of lesions located in vessel larger than 2.5 mm is of proper use. Our current opinion is that coronary stenting is a safe and fast method of coronary transcatheter therapy in many types of coronary lesions and it may be considered the more efficient technique of percutaneous revascularization.