Stents for intracoronary placement: current status and future directions

The technique of intracoronary stenting has achieved remarkable progress over the last few years. Improved stent deployment techniques and optimization of postprocedural management have dramatically improved the safety of intracoronary stent placement. At present, the incidence of early vessel closure after stenting is even lower than that after standard angioplasty and, as most operators no longer prescribe aggressive anticoagulation, bleeding complications are uncommon. Stenting has become an extremely effective treatment for abrupt or threatened vessel closure or for any suboptimal angiographic result during conventional angioplasty. Furthermore, large prospective trials have demonstrated that its efficacy is superior to that of conventional angioplasty for primary restenosis prevention in focal lesions of some native coronary arteries. Ongoing trials tend to extrapolate these conclusions to saphenous vein graft lesions. Mechanical support of the vessel wall explains the sustained angiographic benefit observed after stenting. Future developments may include the use of stents as a vehicle for local drug delivery in an attempt to further reduce the incidence of restenosis. In view of these results, coronary stents should be considered a new standard therapeutic modality in interventional cardiology.