chapter  124
Coronary Stents
Pages 14

Coronary stents were initially introduced as emergency bailout devices to treat obstructive coronary dissections and abrupt vessel closures following PTCA. Stents are now used in more than 95% of all coronary interventions to optimize the angiographic result and reduce the risk of late post PCI coronary restenosis.The early mechanisms by which stents are beneficial in PCI are complex and include a better initial angiographic result compared to PTCA, a scaffolding effect on coronary artery intimal dissections, and endothelial tears with better wound apposition of the endothelial edges, and an improvement in coronary arterial architecture and blood flow characteristics (Fig. 1 and 2).The major late incremental benefit of PCI stent placement over standalone PTCA is the marked reduction in coronary restenosis and resultant lower rate of late target lesion revascularization noted in almost all coronary patient subsets and lesions studied. Paradoxically, coronary stents do not have a significant impact on late patient mortality or myocardial infarction rates.