My stent is better than your stent...Or is it?

Before coronary stents, balloon angioplasty was limited by arterial dissection, acute closure, Q-wave myocardial infarction (MI), a 5% risk for emergency coronary artery bypass graft surgery, the need for repeat procedures to treat restenosis, and sometimes procedural death. Coronary stents immediately reduced those major procedural complications. The current debates about asymptomatic periprocedural biomarker release, late lumen loss, and the anecdotal risk of very late stent thrombosis seem effete compared with prior percutaneous coronary intervention (PCI) challenges and present controversies about PCI or coronary artery bypass graft surgery for left main disease, multivessel disease, bifurcation lesions, and chronic total occlusion. Yet, the painstaking research in PCI that has gone into developing better stent platforms with thinner struts, polymers to coat bare-metal stents, and drugs to elute from those polymers has dramatically reduced the risk of restenosis and need for repeat procedures. It has also expanded the opportunity for PCI as a treatment option for many patients.