Use and Abuse of Coronary Stenting
Keywords:Coronary angioplasty, coronary stenting, drug eluting stents
The introduction of the coronary stent in 1986 remains the only real asset to balloon angioplasty introduced about 10 years earlier. Unfortunately, the undeniable advantages of stenting in terms of preventing abrupt closure and reducing restenosis are not fully exploited. The prognostic benefit to be expected from judicious stenting has been given up by default stenting. Infarctions and lives saved initially by stenting are lost again by stent thrombosis after hospital discharge fraught with a mortality of about 50% by late infarctions. They do not exist after plain balloon angioplasty and are due to stent thrombosis. Because of the comfort benefit that prevails (reduced need for intervention), virtually all interventional cardiologists have subscribed to a policy of 100% stenting and are currently about to adopt active (drug eluting) stents as their default devices for it. Once more, active stents do not confer any prognostic benefit over passive stents but they further reduce restenosis and are appealing to operators and patients. Evidence based medicine condones stenting only in about 50% and active stents in may be 80%. Yet this is ignored for rather irrational reasons.
LicenseAuthors who publish with this journal agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).