Why Have Stents Replaced Balloons? Underwhelming Evidence

Editorials20 May 2003Why Have Stents Replaced Balloons? Underwhelming EvidenceSpencer B. King III, MDSpencer B. King III, MDFrom Fuqua Heart Center; Atlanta, GA 30309.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-10-200305200-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Balloon angioplasty was conceived as a method of alleviating angina by opening obstructed coronary arteries without resorting to bypass surgery. Inflating a nondistensible balloon in a coronary artery results in expansion of the artery and disruption and rearrangement of the plaque, thus enlarging the stenotic lumen. In many patients, such disruption has permanently alleviated the stenosis that leads to ischemia; however, in some patients, acute thrombosis, dissection of the artery, or elastic recoil after deflation of the balloon results in an inadequate lumen with subsequent symptomatic renarrowing. Coronary stenting was first developed as a method to avoid the acute complications ...References1. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994;331:496-501. [PMID: 8041414] CrossrefMedlineGoogle Scholar2. Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994;331:489-95. [PMID: 8041413] CrossrefMedlineGoogle Scholar3. Malenka DJ, Wennberg DE, Quinton HA, O'Rourke DJ, McGrath PD, Shubrooks SJ. Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999. J Am Coll Cardiol. 2002;40:2092-101. [PMID: 12505219] CrossrefMedlineGoogle Scholar4. Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 1999;100:1872-8. [PMID: 10545431] CrossrefMedlineGoogle Scholar5. Popma JJ, Suntharalingam M, Lansky AJ, Heuser RR, Speiser B, Teirstein PS. Randomized trial of 90Sr/90Y -radiation versus placebo control for treatment of in-stent restenosis. Circulation. 2002;106:1090-6. [PMID: 12196334] CrossrefMedlineGoogle Scholar6. Brophy JM, Belisle P, Joseph L. Evidence for use of coronary stents. A hierarchical Bayesian meta-analysis. Ann Intern Med. 2003;138:777-86. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Fuqua Heart Center; Atlanta, GA 30309.Disclosures:Consultancies: BMS Sanofi, Kos Pharmaceuticals, Eli Lilly, Merck & Co., GlaxoSmithKline; Honoraria: BMS Sanofi, Kos Pharmaceuticals, Eli Lilly, Merck & Co.; Grants received: Guidant, Johnson & Johnson, Medtronic, Boston Scientific, Merck & Co.; Royalties: Novoste, Inc. Dr. King has been on the data safety and monitoring boards of trials sponsored by Guidant, Johnson & Johnson, Medtronic, Boston Scientific, and The Medicines Co.Corresponding Author: Spencer B. King III, MD, Fuqua Heart Center, 95 Collier Road, Atlanta, GA 30309. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEvidence for Use of Coronary Stents: A Hierarchical Bayesian Meta-Analysis James M. Brophy , Patrick Belisle , and Lawrence Joseph Metrics Cited ByBare metal stent restenosis is not a benign clinical entity 20 May 2003Volume 138, Issue 10Page: 842-843KeywordsAngiographyAngioplastyClinical trialsDrugsInterventional cardiologyLesionsMyocardial infarctionStent implantationSurgeryThrombosis ePublished: 20 May 2003 Issue Published: 20 May 2003 CopyrightCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...