Stent implantation in human coronary arteries. Clinical and angiographic aspects

Atherosclerotic cardiovascular disease remains one of the most important causes of morbidity and mortality in the industrialized world. Treatment is basically aimed at palliation and consists of either pharmacological intervention or revascularization. The frrst significant advances in the latter were largely surgical [!]. However, the pressing need for treatment with less invasive and potentially less expensive techniques, have stimulated the development of non-surgical revascularization techniques. Percutaneous transluminal coronary balloon angioplasty, which was first performed by Andreas Gruentzig in 1977, is one of the most successful examples and provided the stimulus for a rapid technological growth of interventional cardiology [2]. It is now widely accepted as a safe and effective treatment of obstructive coronary artery disease. However, the risk of abrupt vessel closure during or immediately after the intervention and the risk of late luminal renarrowing or restenosis continue to compromise its overall safety and efficacy [3,4]. To improve the immediate and long-term results of balloon angioplasty, a number of new technologies such as intracoronacy stenting, directional or rotational atherectomy and laser therapy have been developed and represent the leading edge in the battle against atherosclerosis [5-8]. The intracoronary stent has been shown to be effective in the treatment of acute or threatened vessel closure due to balloon angioplasty induced coronary dissection, alleviating the need for emergency bypass surgery [9]. Furthermore, it has been hypothesized that intracoronary stent implantation may reduce the incidence of restenosis by optimizing the immediate angiographic results which should lead to improved long-term clinical outcome