Development of The Intracoronary Stent
From the time of the initial percutaneous balloon angioplasty, it was theorized that devices could be placed inside the arteries as scaffolds to keep them open after a successful balloon angioplasty. This did not become a reality in the cardiac realm until the first intracoronary stents were successfully deployed in coronary arteries in 1986. The first stents used were self-expanding Wallstents. The use of intracoronary stents was quickly identified as a method to treat some complications due to PTCA, and their use can decrease the incidence of emergency bypass surgery for acute complications post balloon angioplasty.
It was quickly realized that restenosis rates were significantly lower in individuals who received an intracoronary stent when compared to those who underwent just balloon angioplasty. A damper on the immediate use of intracoronary stents was subacute thrombosis. Subacute thrombosis rates with intracoronary stents proved to be about 3.7 percent, higher than the rates seen after balloon angioplasty. Post-procedure bleeding was also an issue, due to the intense combination of anticoagulation and anti-platelet agents used to prevent stent thrombosis.
Stent technology improved rapidly, and in 1989 the Palmaz-Schatz balloon-expandable intracoronary stent was developed. Initial results with the Palmaz-Schatz stents were excellent when compared to balloon angioplasty, with a significantly lower incidence of abrupt closure and peri-procedure heart attack. Late restenosis rates with Palmaz-Schatz stents were also significantly improved when compared with balloon angioplasty. However, mortality rates were unchanged compared to balloon angioplasty. While the rates of subacute thrombosis and bleeding complications associated with stent placement were high, by 1999 nearly 85% of all PCI procedures included intracoronary stenting.
In recognition of the focused training required by cardiologists to perform percutaneous coronary interventions and the rapid progression in the field of percutaneous coronary interventions, specialized fellowship training in the field of Interventional Cardiology was instituted in 1999.
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