Coronary stents are now placed in small vessels, diffuse lesions, calcified stenoses, bifurcation lesions, saphenous vein bypass grafts, total occlusions, and ostial lesions. Stents are routinely applied in the settings of acute myocardial infarction and restenotic lesions following balloon angioplasty, and for the treatment of abrupt closure following coronary intervention. Stents are easy to use and decrease procedure time. Stents improve immediate results. Stents improve complication rates by successfully treating acute and threatened artery closure.
Stents improve long-term clinical outcomes by reducing restenosis.
Despite the widespread enthusiasm for coronary stents, concern remains regarding the complications of stent thrombosis, bleeding, stent embolization, and side-branch occlusion. 9 Intense interest also exists for the cost of coronary stents and their impact on the healthcare environment. The procedural techniques should be tailored to the stent design and the coronary stenosis scenario. All efforts should result in maximal lumen enlargement and full stent expansion, elimination of any residual dissection, and avoidance of stent overlap. Improved stent designs, clinical experience, and several randomized trials demonstrated that poststent antiplatelet therapy alone is not only superior to full anticoagulation with Coumadin but it yields fewer complications and, because of decreased length of stay, decreases the cost of hospitalization.