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Education in Heart
CORONARY DISEASE
Role of stenting in coronary revascularisation
  1. Anthony H Gershlick
  1. Glenfield Hospital, Leicester, UK
  1. Dr AH Gershlick, Glenfield Hospital, Leicester LE3 9QP, UKagershlick{at}aol.com

https://doi.org/10.1136/hrt.86.1.104

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    Percutaneous treatment for atheromatous coronary disease has developed rapidly in the last 5–10 years. Some technologies, such as laser therapy, have fallen by the wayside as clinical trials and clinical experience demonstrates lack of efficacy or excess complications. Others devices such as intravascular ultrasound are no longer used routinely. Stent use has grown exponentially, however, initially because operators perceived that angioplasty with adjunctive stenting was safer. Developments allowed the procedure to be increasingly undertaken quickly and safely with short inpatient stay. However, treating patients needs to be evidence based. This article highlights the evidence that underpins the clinical impression that stent deployment is now central to percutaneous treatment of coronary artery disease.

    Background

    Atheromatous coronary artery disease (CAD) has a major impact on health and on medical economics. There are 150 000 admissions for acute myocardial infarction in the UK annually, and the prevalence of angina has been estimated to be between 1–3% (up to 1.8 million for a population of 60 million). The incidence of new angina varies from 3.6–7.9%. Gandhiw1 has published an annua1 incidence of 0.44/1000/year in the younger age group (26 000/year) and 2.32/1000/year in patients aged 61–70 years (139 000/year or 2320/million/year). Much of the presentation of CAD is the result of progression, or dynamic change, in the coronary atheromatous plaque. Important treatment aims should be stabilisation of the plaque, restoration of flow, and the alleviation of any flow limitation. Mechanical means to negate the effects of atheromatous obstruction (be they coronary surgery or percutaneous intervention) play an important part in improving the outcome in those patients with CAD.

    Percutaneous coronary intervention (PCI) has become an increasingly used and successful treatment option over the last 20 years. It has undergone various evolutionary changes and “came of age” in 2000 with the endorsement of routine stent use by the …

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