THE STATE AT THE STENT - CURRENT PRACTICES CONTROVERSIES, AND FUTURE-TRENDS

Stent use has been increasing steadily over the last 5 years and might be viewed as the ''second wind'' of angioplasty. A large number of di fferent stents are now available, and many trials have been designed t o assess their safety and efficacy. But do comparisons of the various stents serve a useful purpose-i.e., do they address real medical quest ions? Many issues remain unresolved, such as who should and should not be stented, what the actual costs are of this modality, and what the future holds in terms of multifunctional devices. In addition, researc h is under way to explore such areas as techniques for stent guidance, the role of anticoagulation and adjunctive therapies, treatment of pa tient subsets (e.g., those with ischemic syndromes or challenging coro nary anatomy), and synergistic approaches (e.g., directional atherecto my, radiotherapy, laser angioplasty). The results of such studies are likely to change the face of interventional cardiology.