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Use of intracoronary stents for specific coronary lesions

Donald Cutlip, MD
Section Editor
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Percutaneous coronary intervention (PCI) refers to both nonstenting procedures and stent interventions. Stenting represented an advance over percutaneous transluminal coronary angioplasty (PTCA) alone because acute procedural success was higher and the rate of restenosis requiring target lesion revascularization was much lower. Approximately 20 to 30 percent of patients required clinically-driven repeat target lesion revascularization within the first year after PTCA alone compared to 10 to 15 percent with bare-metal stents [1-3].

Drug-eluting stents (DES) represented a further advance in PCI and are now used in the majority of procedures. In addition, newer generation DES are used in preference to first generation DES. (See "Drug-eluting intracoronary stents: General principles", section on 'Efficacy and safety compared to BMS' and "Comparison of drug-eluting intracoronary stents", section on 'Comparison of all DES'.)

The use of PCI for specific coronary lesions will be reviewed here. The emphasis will be on the outcomes with DES. Issues related to the use of DES, the major clinical trials demonstrating the efficacy of DES compared to bare-metal stents, and the general principles of stent deployment are discussed separately. (See "Drug-eluting intracoronary stents: General principles" and "Clinical use of intracoronary bare metal stents" and "General principles of the use of intracoronary stents".)


The 2007 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions focused update for percutaneous coronary intervention recommended use of a drug-eluting stent (DES) as an alternative to bare-metal stents in patients with lesions for which a favorable efficacy and safety profile has been demonstrated in clinical trials [4]. Use of a DES with other lesions could be considered but the efficacy was less well established.

Patients with DES may require more prolonged dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker because of a possible increased risk of late stent thrombosis, especially if therapy is interrupted for noncardiac surgery. As a result, a bare-metal stent or balloon angioplasty was recommended for those patients in whom surgical or invasive procedures were likely in the 12 months following DES implantation. The importance of antiplatelet therapy to prevent stent thrombosis, updated guideline recommendations, and recommended regimens with the different types of stents are discussed separately. (See "Coronary artery stent thrombosis: Incidence and risk factors" and "Long-term antiplatelet therapy after coronary artery stenting in stable patients" and "Antithrombotic therapy for elective percutaneous coronary intervention: General use".)


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Literature review current through: Sep 2016. | This topic last updated: Aug 24, 2016.
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