Use and Abuse of Coronary Stenting

Abstract

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.