Coronary stenting

W. Wieling
Department of Internal Medicine, Academic Medical Center, University of Amsterdam, (The Netherlands)

Introduction

 In the early years of percutaneous coronary intervention (PCI) the only available method to treat coronary stenoses was balloon angioplasty. However, balloon angioplasty alone, also known as plain old balloon angioplasty (POBA) was hampered by a few important technical limitations. For example, an important early complication of POBA was acute vessel closure,  which could only be treated with emergency coronary artery bypass graft surgery (CABG).(1) Moreover, acute vessel recoil at the site of balloon inflation led to suboptimal early results of POBA, and restenosis rates were frequently reported to be >20%.  The introduction of coronary artery stents, pioneered by Julio Palmaz, Richard Schatz, Cesare Gianturco and Gary Roubin,  led to important advances in PCI.(2) By virtually eliminating acute vessel closure, hospitals were PCIs were performed no longer needed a surgical backup team, and for many years now PCIs are performed in hospitals without cardiothoracic surgery departments. Moreover, restenosis rates were reduced by as much as 50% with the use of bare metal stents (BMS) compared with POBA.(3, 4) However, the introduction of the BMS also introduced the complication of stent thrombosis which occurs in 2-5% of patients depending on lesion and patient characteristics. More recently, at the beginning of the current millennium drug-eluting stents (DES) caused another revolution in PCI. Again, restenosis rates were cut in half compared with BMS and the latest generation of DES with bio-compatible polymers have been shown to reduce stent thrombosis compared with BMS. This section provides an overview about technical specifications, and data on safety and efficacy of different types of coronary artery stents.

Editor's comments

Table 2:Typical Premonitory Symptoms for Reflex Syncope
Lightheadedness, dizziness Palpitations Weakness Dimming or blurred vision Fading hearing, tinnitus Nausea, epigastric distress Feeling warm or cold Facial pallor Sweating, dilated pupils

References

1. Wieling W, Ganzeboom KS, and Saul JP. Reflex syncope in children and adolescents. Heart. 2004 Sep;90(9):1094-100. DOI:10.1136/hrt.2003.022996 |