Colombo's Tips & Tricks for Drug Eluting Stents PDF

Preface

The introduction of drug-eluting stents represents a major landmark in cardiovascular medicine because it offers the possibility of shifting the mode of treatment of ischemic heart disease towards percutaneous intervention.

This fact represents a historical milestone: ‘restenosis has been conquered after more than a decade of siege'.

The pleasure in writing about the usage of drug-eluting stents is enormous because for the first time we are able to experience the feeling that what we are doing will most likely continue for some time to come.

As Dr Paul Teirstein wrote, ‘it is a nice feeling for a surgeon to realize that the gallbladder he just removed will not grow back again', and we are now experiencing the same feeling when we place a drug-eluting stent in a stenosis and we are able to see the final result and know that this result will stay as it is for a long period of time

 Technical changes brought about by the introduction of drug-eluting stents are enormous. The most important and fundamental of these is that we are not afraid to implant a long stent. In the early days of coronary stenting I made a presentation that stated that a stent is a prosthesis and needs to be anchored on healthy tissue (vessel). This statement introduced the concept of stenting from healthy to healthy. Unfortunately the appearance of diffuse in-stent restenosis quickly demanded a revision of this approach to one of full lesion coverage. Under some criticism, we tried to introduce the technique of spot stenting: a laborious, time-consuming and sometimes uncertain approach. No more spot stenting, or as Dr Marty Leon remarked: ‘Antonio you should "stent every spot"'. We are delighted we can ‘stent every spot' and that we can go back to the concept of full lesion coverage.

The philosophy of this book and the CDs that accompany it, is to convey most of the new technical elements brought into play by the usage of drug-eluting stents and by their different performance characteristics. The concepts expressed are a clear departure from our prior work Tips & Tricks in Interventional Cardiology. The emphasis now is to be able to treat most, if not all, the clinically relevant lesions. We are no longer afraid of diffuse disease, small vessels or bifurcations; we now feel more secure when treating unprotected left main lesions. We have tried to give more emphasis to detailed description of cases and to summarize in a simple message the most relevant teaching points. As usual, we unfortunately have a section about complications and problems, a section which perhaps one day will cease to exist. Nevertheless, this section is a little smaller than in the past, with coronary perforations and ruptures being the main representatives. An important message to the industry is for it to provide the interventional cardiologist with better tools with which to treat these types of complications.

Compared with our previous publication, we now have additional co-authors, all of whom have done an excellent and timely job and I would like to thank them again.

Dr Goran Stankovic has been responsible for pushing me to undertake this second project and as a ‘punishment' he has had to contend with a year of intense work to help with all the editing. This book would have never been completed without Goran's support. Giovanni Martini also requires specific recognition for all his superb skills in putting together the images and videos, that are so important in this type of presentation. Finally, special thanks to Alan Burgess at Martin Dunitz who made this publication possible and was instrumental in the introduction of a number of helpful new features.