Coronary artery stenting

Intracoronary stents are used to treat vessel closure following percutaneous transluminal coronary angioplasty (percutaneous coronary intervention (PCI)).

Vessel closure is usually due to:

• residual atheromatous stenosis
• dissection of the coronary artery

When compared to angioplasty alone, stenting a lesion reduces the restenosis rate.

The thrombogenicity of intracoronary stents requires the use of either antiplatelet or anticoagulant therapy for four weeks post-procedure.

Combined anti-platelet therapy has been shown to be more effective and safer than anti-coagulation.

Coronary artery stents should be routinely used in the management of patients with angina (stable or unstable) or myocardial infarction where percutaneous coronary intervention is the clinically appropriate procedure (1).

• stents are implanted in nearly all patients undergoing PCI (94% in the Euro-Heart Survey 2006) because of several advantages over simple balloon dilatation:
  • a lower incidence of restenosis and consequently a reduced need for medical treatment and repeat procedures for recurrent angina
  • the achievement of a consistently larger vessel lumen with more predictable relief of myocardial ischaemia
  • the ability to treat complex lesions for which coronary bypass grafting would otherwise be required
  • a more stable immediate result and reduced risk of early (peri-procedural) abrupt closure of the treated artery

For patients with either stable or unstable angina, or acute myocardial infarction and where percutaneous coronary intervention is the clinically appropriate procedure, stents should be routinely used (1).

Reference:

• (1) NICE (May 2000). Coronary artery stents in the treatment of IHD.
• (2) British Heart Foundation Factfile (May 2008). Managing patients with coronary stents