Plaque rupture leads to acute coronary syndrome (ACS including STEMI, NSTEMI, unstable angina). Medical and revascularization therapy was established for the patients with ACS. Coronary stent has been developed from bare metal stent to drug eluting stent. Moreover revascularization for ACS has been changing from stenting alone to facilitated stenting (use of thrombolytic agent before stent implantation) in Japan. Distal protection device has been attracted attention to new trend for ACS patients. Coronary stent is going to new generation and stenting for ACS is also changing in near future.