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Related Experiment Videos

Beyond stents: third-generation coronary devices

S N Oesterle1

  • 1Department of Medicine, UCSF/Stanford Health Care, California, USA. steve_oesterle@cvmed.stanford.edu

The Annals of Thoracic Surgery
|October 13, 1998
PubMed
Summary
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New coronary devices address limitations of angioplasty, atherectomy, and stenting. Third-generation technologies aim to overcome restenosis, chronic total occlusions, small-vessel disease, and vein graft issues.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Percutaneous transluminal coronary angioplasty (PTCA) has seen significant growth, yet bypass grafting remains common.
  • Second-generation devices like atherectomy and stents expanded PTCA applications for complex lesions.
  • Stents reduced restenosis but showed limited benefit in smaller vessels or longer stenoses.

Purpose of the Study:

  • To review the evolution of coronary interventional devices.
  • To identify limitations of existing percutaneous coronary interventions.
  • To introduce novel, third-generation devices addressing these limitations.

Main Methods:

  • Review of second and third-generation coronary interventional devices.
  • Analysis of device applications and limitations in treating coronary artery disease.

Related Experiment Videos

  • Identification of emerging technologies for specific coronary pathologies.

    • Main Results:

    • Second-generation devices effectively treat eccentric, calcified lesions, and dissections.
    • Stent benefits for restenosis are primarily in larger vessels (>3mm) and shorter lesions (<20mm).
    • Third-generation devices target restenosis (brachytherapy), chronic total occlusions (laser), small vessels (laser revascularization), and vein grafts (antiembolization).

    Conclusions:

    • Despite advancements, challenges like restenosis and diffuse disease persist.
    • Novel catheter technologies are emerging to address these unmet needs.
    • New devices require clinical and economic evaluation against evolving surgical techniques.