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(Circulation. 2007;116:2363-2365.)
© 2007 American Heart Association, Inc.

Editorial

Et Tu, Bare Metal Stent?

David O. Williams, MD; J. Dawn Abbott, MD

From the Division of Cardiology, Department of Medicine, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, RI.

Correspondence to David O. Williams, MD, APC 814, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail dowilliams@lifespan.org

Key Words: Editorials • coronary disease • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

When performing percutaneous coronary revascularization, physicians nearly always supplement balloon angioplasty with a stent.¹ This decision is based on evidence that stent implantation enhances the procedural success and durability of angioplasty. Benefits of stenting, compared with balloon angioplasty, include a reduction in the incidence of lesion recurrence, manifested as reduced need for repeat revascularization and lower rates of periprocedural myocardial infarction (MI).^2–5 The major shortcoming of bare metal stents (BMS) is that 20% of native vessel and 30% of saphenous vein graft patients develop angiographic restenosis from neointimal hyperplasia. About half of these patients will have clinical restenosis and require repeat revascularization. In contrast to the favorable results of stents in de novo lesions, stenting of in-stent restenotic lesions with BMS results in more restenosis. Before the drug-eluting stent (DES) era, of multiple therapies investigated, only intracoronary brachytherapy was effective in preventing recurrent in-stent restenosis.^6,7

Article p 2391

Fortunately, the DES was developed to suppress neointimal hyperplasia, and several randomized, double-blind, clinical trials demonstrated the ability of DES to substantially reduce the incidence of in-stent restenosis.^8–10 Within a short time after commercialization, DES nearly replaced BMS in the United States, and the number of patients requiring repeat revascularization fell substantially.¹

As clinical restenosis became infrequent, another potential and untoward event related to stents became more exposed—namely, stent thrombosis. This disorder can cause abrupt coronary occlusion and frequently clinically manifests as acute MI or death. Although stent thrombosis was common during the early years of BMS use, improvements in the technique . . . [Full Text of this Article]

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