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New developments in coronary stent technology

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Current performance standards are high and promising new technologies are finding it difficult to compete

The narrative review in this issue of the MJA by Chen and Jepson1 outlines the enormous advances made in stent technology since Sigwart and colleagues published the first report on the clinical use of coronary stents in 1987.2 Driven by technological progress and rigorous scientific study, coronary stents have advanced rapidly to the stage where a patient’s coronary stenosis can be safely and reliably opened.

A 60-year-old man is brought to the emergency department with severe chest pain, his electrocardiogram showing marked anterior ST elevation. He has a ventricular fibrillation arrest and is shocked into sinus rhythm. Catheterisation laboratory staff are on their way and, within minutes of arrival, a coronary angiogram shows complete occlusion of the left anterior descending artery. A guide-wire is inserted and flow is established after balloon inflation. His pain is settling as a drug-eluting stent is inserted. He is discharged on Day 3.

Despite benefiting dramatically from stent technology, our patient’s future is not without risks and challenges. He needs to take dual antiplatelet drugs for 1 year and postpone elective surgery. Over the next 5 years, he faces a stent thrombosis rate of 1.4–4.0%, and an almost…