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(Circulation. 1997;95:308-310.)
© 1997 American Heart Association, Inc.

Articles

Intravascular Stent Endothelialization

A Goal Worth Pursuing?

Darren B. Schneider, MD; David A. Dichek, MD

the Gladstone Institute of Cardiovascular Disease and the Daiichi Research Center, University of California, San Francisco.

Correspondence to David A. Dichek, MD, Gladstone Institute of Cardiovascular Disease, PO Box 419100, San Francisco, CA 94141-9100. E-mail david_dichek@quickmail.ucsf.edu

Key Words: Editorials • stents • endothelium • thrombosis • endothelium-derived factors

	Introduction

 
The explosive growth of interventional cardiology has been accompanied by a proliferation of devices designed both to eliminate coronary stenoses and to prevent their recurrence. The intravascular stent is certainly one of the most successful of these devices. First deployed in humans in 1986¹ and approved by the FDA in 1993, an estimated 100 000 intracoronary stents per year are deployed in the United States (personal communication, Martin B. Leon, MD, Washington Hospital Center, Washington, DC). No interventional facility in 1996 can be without the capability for stent deployment. Stents are useful both for acute closure and for improving the long-term success of balloon angioplasty. In selected populations, stent deployment decreases the rate of restenosis after coronary angioplasty, as demonstrated by the STRESS² and Benestent³ trials.

Despite their utility, intracoronary stents have been plagued by two problems during their development: acute occlusion due to thrombosis and the persistent occurrence of restenosis. Initial reports of intracoronary stent deployment in humans noted stent-related thrombosis rates of 3% to 4% under elective conditions,^{2 3} rising to 8% to 16% in bailout or emergency situations.⁴ These unacceptably high rates were initially combated with aggressive drug therapy, including both anticoagulant and antiplatelet agents. This therapy decreased stent thrombosis but did so at a cost of additional hours of patient care as well as increased vascular and bleeding complications, leading to longer hospital stays and higher hospital bills.^{2 3} In-stent restenosis remains a significant clinical problem, with rates of 13% even in the more optimistic studies.⁵

More progress . . . [Full Text of this Article]

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