ABSTRACT
The mechanical scaffold provided by coronary stents has represented a dramatic improvement in our techniques of percutaneous myocardial revascularization, and this improvement has been particularly valuable for the treatment of complex lesions. In the last few years, however, promising data have been accumulating that may lead to a second revolution based on a stent platform, namely the use of drug-eluting stents that inhibit late intimal hyperplasia and restenosis.1-4 Again, complex lesions will be the most important target for these new devices, because the restenosis rate for small vessels, bifurcational lesions, and total occlusions is often higher than 30%. If stents have allowed treatment of complex lesions with a low immediate risk and a high success rate, the drug elution process can transform this short-term favorable outcome into a long-term patency and persistent benefit. On the verge of this new revolution, it is particularly difficult to write about the treatment of complex lesions, as our techniques will be drastically modified by the use of these prostheses. In this chapter, we will try, however, to summarize what we know about the treatment of complex lesions with metallic stents in the specific subsets of lesions in bifurcations, lesions located in vessels of small reference diameter, and in chronic total occlusions.
