Update on interventional cardiology: outcome according to stent type and implantation technique

![Graphic][1] After Andreas Gruntzig’s seminal first coronary angioplasty with a self-designed balloon nearly 40 years ago in Zurich,1 it became obvious that dissections and restenosis formation severely hampered the success of this elegant approach to coronary artery disease. The implantation of metallic stents, first attempted by Ulrich Sigwart in Lausanne,2 revolutionized percutaneous coronary intervention in the early 1990s. Coronary stents restrain dissection flaps and create a regular, usually round vessel lumen which reduces the chances of acute coronary occlusion.3 Stents also optimize acute lumen gain, prevent early vessel recoil, and limit the constrictive effect of late adverse vessel remodelling. However, the inevitable late increase in neointima formation caused by the metallic cage remained a major drawback of bare metal stents. In their Current Opinion ‘ Is it time to take bare metal stents of f the catheter laboratory shelf? ’, George Kassimis and colleagues from the Gloucestershire Hospitals NHS Foundation Trust in Cheltenham, UK4 argue that the development of drug-eluting stents—combining polymer technology with antiproliferative drugs to improve the medium and long-term predictability of stent implantation—has led to products that are so superior to previous devices that bare metal stents should be abandoned altogether. Stents of any kind are associated with a considerable risk of stent thrombosis5,6 requiring effective dual antiplatelet therapy for prolonged periods of time. During the percutaneous coronary intervention, anticoagulation to inhibit thrombin formation is also required. In their clinical review ‘ Anticoagulation in coronary intervention : acute and chronic use ’, Uwe Zeymer and colleagues from the Klinikum Ludwigshafen in Germany remind us that percutaneous coronary intervention by itself indeed induces thrombin generation that is associated with the risk of acute, subacute, or long-term ischaemic events.7 Therefore, intravenous anticoagulation is recommended to minimize acute and long-term thrombotic complications. The … [1]: /embed/inline-graphic-1.gif