Early attempts at percutaneous coronary intervention (PCI) using balloon angioplasty were largely hampered by technical limitations. Although balloon angioplasty was moderately successful at relieving an obstruction, the procedure frequently resulted in dissections which, if uncontrolled, often led to abrupt vessel closure. Furthermore, while acute luminal gain could be impressive, a combination of elastic recoil and smooth muscle hyper-proliferation often negated the benefits of an acceptable immediate angiographic result. Elastic recoil could occur minutes to hours post-procedure resulting in acute myocardial infarction (AMI) and need for emergent coronary artery bypass grafting (CABG). This led to a pivotal development in the history of PCI with introduction of the metallic stent, which drove rapid improvements in short- and long-term procedural safety and efficacy. Stent design has been a remarkable area of technological advances with pivotal milestones including evolution of metallic architecture and introduction of the drug-eluting stent (DES). Although DES is now considered the default option for most PCI, bare-metal stents (BMS) still represent a sizeable proportion of stent procedures in some countries and in some settings may have arguable advantage. In this chapter we aim to review contemporary evidence for the use of BMS in modern interventional practice.
Copyright 2018, The Author(s).