Percutaneous coronary intervention for small-vessel coronary disease: highlight on the everolimus-eluting stent

Smaller coronary arteries are less able to accommodate late loss after percutaneous coronary interventions than larger arteries. The first-generation drug-eluting stents have been shown to have better control of neo-intimal hyperplasia and lower late lumen loss compared with bare-metal stents. However, the reported rates of binary restenosis are still unsatisfactory and small target vessel interventions remain challenging. Recently, a study using a subset of the SPIRIT III trial has demonstrated that the everolimus-eluting stent lowered late lumen loss, rates of binary restenosis and target lesion revascularization compared with the paclitaxel-eluting stent. In this article, we review previous studies evaluating small-vessel interventions and focus on the everolimus-eluting stent in this clinical entity.