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Clinical Review Fortnightly review

Intracoronary stents

BMJ 1999; 318 doi: (Published 06 March 1999) Cite this as: BMJ 1999;318:650
  1. Manish M Gandhi, senior registrar in cardiology,
  2. Keith D Dawkins, consultant cardiologist
  1. Wessex Cardiothoracic Centre, Southampton University Hospital, Southampton SO16 6YD
  1. Correspondence to: Dr Gandhi

    During the past five years there has been a sharp increase in the use of intracoronary stents as an adjunct to percutaneous transluminal coronary angioplasty (PTCA) for the revascularisation of patients with angina. In 1996 stents were used in half (mean 46%, range 15-99%) of the 20 500 PTCA procedures undertaken in the United Kingdom, representing a fivefold increase since 1994(HH Gray, personal communication).

    Stents were developed to improve clinical outcome after PTCA. In selected patients, PTCA is as effective as bypass surgery,1 and more effective than medical treatment,2 in relieving angina. The early benefit of PTCA over medical treatment particularly applies to patients with severe angina and single vessel coronary artery disease at baseline. This benefit, however, diminishes during long term follow up and in patients with multivessel coronary artery disease, partly because repeat revascularisation is required for restenosis. 3 4 In the early days after the first PTCA was performed in 1977, abrupt periprocedural closure of vessels and late angiographic restenosis were apparent.5 In an attempt to overcome these limitations, the first report of 24 coronary stents deployed in 19 patients was published 10 years later.6

    Fig 1

    Balloon catheter (a), and close up of tip with balloon mounted coronary stent (b)

    Summary points

    Intracoronary stents increase luminal diameter, seal intimal flaps, limit vessel recoil, and reduce vascular remodelling to provide a wider and smoother coronary lumen than balloon angioplasty alone

    50-90% of coronary angioplasty procedures are followed by elective intracoronary stenting; this improves angiographic and clinical outcomes in patients undergoing percutaneous revascularisation for stable and unstable angina, reducing the need for repeat intervention

    The role of intracoronary stenting in acute myocardial infarction remains unproved; it may be considered in selected patients when reperfusion with thrombolysis is contraindicated or fails

    Randomised trials are under way to compare intracoronary …

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