Abstract
When Andreas Gruntzig performed the first percutaneous transluminal coronary angioplasty in 1978, he did not expect that this procedure would become one of the most often performed interventions in medicine worldwide. The Achilles' heels of balloon angioplasty were early reocclusions and restenosis. However, >60% of the patients after plain old balloon angioplasty did well without any need for repeat target lesion revascularizations. With the introduction of stents, the procedure became more predictable with respect to early reocclusions and the rate of clinically driven repeat revascularization procedures declined to ∼20%, depending on lesion characteristics such as vessel diameter and lesion length and concomitant diseases such as diabetes mellitus and renal insufficiency. However, in randomized clinical trials, no benefit in death and re-infarction was observed with stenting, compared with balloon angioplasty alone.1 Despite this fact, currently, ∼80–90% of the percutaneous coronary interventions (PCIs) are performed with a stent. Soon it became clear that even stents were associated with considerable restenosis rates in some subgroups, namely, diabetics, bifurcation lesions, in-stent restenosis, and long lesions in small vessels. The availibility of drug-eluting stents (DESs) represented a major advance for the reduction of restenosis.2 Very consistently, the two approved DESs, CYPHER and TAXUS, have been shown to reduce the amount of late lumen loss in the months following implantation, compared with bare metal stents (BMSs).3 This difference was associated with a marked reduction in the rate of restenosis and the need for target vessel revascularization in randomized clinical trials. The … *Corresponding author. Tel: +49621 503 4045; fax: +49621 503 4002. E-mail address : uwe.zeymer{at}t-online.de
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