Stents and Vascular Woundhealing

For many years, percutaneous trans luminal coronary angioplasty (PTCA) has been used to treat diseased, llanowed vessels. While it has been a great success in improving patient outcome, the teciUlique is not free from complications: restenosis, dissections and abmpt closures are serious complications of the technique, necessitating repeat revascularization or surgery. ExpeIimental animal studies suggested that the results of PTCA could be improved by scaffolding the intemal wall of the artery with a stent, an idea first proposed in 1912 by Carre. In the late 1960's Dotter gave new impetus to this idea, and in 1986 the first human coronary stent implantation followed. Initial stent implantations were associated with high thrombosis rates and results of stent trials were greeted cautiously or even skeptically by some. In 1994 however, the results of the European BENES TENT and American STRESS trials were published. In these trials restenosis rates after balloon angiopiasty or Palmaz-Schatz stent implantation were compared, and showed significant reductions in restenosis rates after stenting (BENESTENT: 22%; STRESS: 32%) compared to angioplasty alone (BENESTENT: 32%; STRESS: 42%). These landmark trials heralded the start of an exponential growth in the use of endovascular stents, such that today, stenting has become accepted as a standard therapeutic modality in interventional cardiology. Current clinical indications for the use ofstents include: (1) the primary reduction in restenosis in de novo focal lesions in vessels greater then 3.0 mm in diameter, (2) focal lesions in saphenous vein grafts and (3) the treatment of abmpt or threatened vessel closure during angioplasty. However, as the variety and sophistication of stenting devices improves, new applications are being found. Currently there are more than 55 standard or customized stent types available for use in the coronary system manufactured by more than 30 different companies.

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