Coronary Stenting

In the last twenty-five years, coronary stenting stands as the cornerstone of modern day interventional cardiology. Today many choices exist for interventionalists with the most basic delineation being bare metal stents (BMS) and drug eluting stents (DES). Within each broad category there are multiple stent delivery systems, sizes, structural differences, various metal compositions, and anti-proliferative agents for drug eluting.

There are several controversies currently surrounding coronary stents. Despite the fact that DES has been proven to decrease vessel restenosis when compared to bare metal stents, the first generation of DES increased the occurrence of late stent thrombosis, which was uncommon with bare metal stents. Additionally, stents have been used for multiple types of lesions with a significant number of these being considered off label indications. Lastly, the duration of dual anti-platelet therapy with aspirin and clopidogrel following stent implantation, especially DES, needs to be further examined by the medical community. Despite current topics of debate in stenting, much promise exists in coronary intervention with bio-absorbable stents and anti-proliferative balloons currently in development.

An understanding of the various principles of coronary stenting factors, including patient appropriateness, potential complications, and peri-operative management, is necessary for any healthcare provider currently treating cardiac patients. Perhaps most importantly, a firm understanding of the importance of dual anti-platelet therapy can have a significant impact on the prevention of stent complications, especially stent thrombosis, which is often associated with significant mortality. This guide will serve as a reference for those healthcare providers who evaluate potential coronary stenting patients, as well as to help them properly manage those who are already stent recipients. Using the ultra-concise, portable format of the Oxford American Pocket Note series, this volume will prove to be a practical guide for interventionalists seeking a quick reference in coronary stenting.

Anthony A. Bavry, MD, MPH, Associate Professor of Medicine, Division of Cardiovascular Medicine, University of Florida

R. David Anderson, M.D., F.A.C.C., Division of Cardiovascular Medicine, Associate Professor of Medicine, Director, Interventional Cardiology

William Brearley, M.D., Resident, University of Florida