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Why Have Stents Replaced Balloons? Underwhelming Evidence

Spencer B. King III, MD
[+] Article, Author, and Disclosure Information

From Fuqua Heart Center; Atlanta, GA 30309.

Potential Financial Conflicts of Interest:Consultancies: BMS Sanofi, Kos Pharmaceuticals, Eli Lilly, Merck & Co., GlaxoSmithKline; Honoraria: BMS Sanofi, Kos Pharmaceuticals, Eli Lilly, Merck & Co.; Grants received: Guidant, Johnson & Johnson, Medtronic, Boston Scientific, Merck & Co.; Royalties: Novoste, Inc. Dr. King has been on the data safety and monitoring boards of trials sponsored by Guidant, Johnson & Johnson, Medtronic, Boston Scientific, and The Medicines Co.

Requests for Single Reprints: Spencer B. King III, MD, Fuqua Heart Center, 95 Collier Road, Atlanta, GA 30309.

Ann Intern Med. 2003;138(10):842-843. doi:10.7326/0003-4819-138-10-200305200-00013
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Balloon angioplasty was conceived as a method of alleviating angina by opening obstructed coronary arteries without resorting to bypass surgery. Inflating a nondistensible balloon in a coronary artery results in expansion of the artery and disruption and rearrangement of the plaque, thus enlarging the stenotic lumen. In many patients, such disruption has permanently alleviated the stenosis that leads to ischemia; however, in some patients, acute thrombosis, dissection of the artery, or elastic recoil after deflation of the balloon results in an inadequate lumen with subsequent symptomatic renarrowing. Coronary stenting was first developed as a method to avoid the acute complications of balloon angioplasty. The availability of stents has led to a marked decline in the need for bypass surgery after an intervention. At Emory University from 1980 to 1990, approximately 5% of the patients requiring intervention had surgery during the hospital admission. That figure decreased to 2.75% from 1992 to 1995 and to 1.27% from 1996 to 2000, at which time stents were widely available. Stenting would inevitably also be used to address the other major limitation of angioplasty—restenosis during the healing phase.



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