The state of the stent: current practices, controversies, and future trends

Stent use has been increasing steadily over the last 5 years and might be viewed as the "second wind" of angioplasty. A large number of different stents are now available, and many trials have been designed to assess their safety and efficacy. But do comparisons of the various stents serve a useful purpose-i.e., do they address real medical questions? Many issues remain unresolved, such as who should and should not be stented, what the actual costs are of this modality, and what the future holds in terms of multifunctional devices. In addition, research is under way to explore such areas as techniques for stent guidance, the role of anticoagulation and adjunctive therapies, treatment of patient subsets (e.g., those with ischemic syndromes or challenging coronary anatomy), and synergistic approaches (e.g., directional atherectomy, radiotherapy, laser angioplasty). The results of such studies are likely to change the face of interventional cardiology.