Effects of endoluminal coronary stents on the frequency of coronary artery bypass grafting after unsuccessful percutaneous transluminal coronary revascularization

Endoluminal coronary artery stents have been quickly incorporated into clinical practice in order to reduce restenosis and to deal with unsatisfactory initial results (including actual or threatened abrupt closure) of percutaneous transluminal coronary revascularization (PTCR).(1) The incremental expense of this new technology is a source of considerable concern, particularly in an era in which reimbursement is increasingly based on a fixed rate. The direct cost of the stent and the prolonged length of stay required by the currently recommended anticoagulant regimen threaten the practicality of this technology and the fiscal viability of interventional programs that utilize it. Only improved outcomes can justify the increased initial expense. The reduced restenosis rates observed in the Belgian Netherlands Stent Study (BENESTENT)(2) and the Stent Restenosis Study (STRESS)(3) must translate into clinical practice, and the expected reduction in the rate of periprocedural ischemic complications through the use of stents for ''bail out'' of threatened or completed abrupt closure must be realized. Moreover, newer approaches to the technique of stent deployment(4) may eliminate the need for a rigorous anticoagulation regimen in many patients and thereby avoid lengthy hospital stays. This article describes the clinical and operational impact of the introduction of stents on a regular clinical basis to our busy angioplasty program.