Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2017; 9(3): 207-211
Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.207
Coronary stenting: A matter of revascularization
Aldo Bonaventura, Fabrizio Montecucco, Luca Liberale
Aldo Bonaventura, Fabrizio Montecucco, Luca Liberale, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
Author contributions: Bonaventura A, Montecucco F and Liberale L wrote the article; Bonaventura A and Liberale L designed the figure; Montecucco F supervised the drafting of the entire article.
Conflict-of-interest statement: Bonaventura A, Montecucco F and Liberale L declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabrizio Montecucco, MD, PhD, Associate Professor, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, 6 viale Benedetto XV, 16132 Genoa, Italy. fabrizio.montecucco@unige.it
Telephone: +39-010-3538694 Fax: +39-010-3538686
Received: October 12, 2016
Peer-review started: October 17, 2016
First decision: November 14, 2016
Revised: November 15, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: March 26, 2017
Processing time: 165 Days and 0.5 Hours
Abstract

In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention (PCI) and the use of balloon catheters, bare metal stents (BMSs), and drug-eluting stents (DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion re-stenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of in-stent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a re-narrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced re-stenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and anti-proliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy (DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.

Keywords: Drug-eluting stent; Bare metal stent; In-stent re-stenosis; Stent thrombosis; Coronary artery disease

Core tip: Percutaneous coronary intervention (PCI) has made progress in leaps and bounds in the last 20 years. Complications occurring with catheter balloons and bare metal stents have been overwhelmed by drug-eluting stents (DESs), especially the new-generation ones. They are characterized by innovations in design, metal composition, surface polymers, and anti-proliferative drugs, thus reducing the risk for stent thrombosis and greatly improving revascularization outcomes. DESs also need dual antiplatelet therapy (DAPT), but the latter implies bleeding complications, too. Patients undergoing PCI should be implanted with DESs and DAPT should be tailored on each patient considering the bleeding risk.