RE CUMPSTON
I read with great interest Dr. Neil Cumpston's editorial about the complete stent [1]. A few points puzzled me, and I do hope that Dr. Cumpston will be kind enough to clarify. He seems to imply that the most desirable quality of a stent is just the ability to track. I am sure that he will agree that besides high procedural success rate, a complete stent also must have a low restenosis rate. In-stent restenosis is becoming more and more of a problem as we implant more and more stents.
It was quoted in the editorial that in the expanded state (of the Micro Stent), irregular angiographic appearance occurs but does not translate into an increased rate of subacute thrombosis. Yet we know that four patients (5%) developed subacute stent thrombosis [2,3]. Although the lack of ticlopidine usage may be one of the reasons, perhaps prolapsing of tissue in between the stent struts would be another possible reason. It is also worth mentioning that perhaps the stent is not fully deployed at max pressure of 12 Barrs.
Although this particular study shows a restenosis rate of ฯณ13% in 6 months [2], some studies using the Micro Stent quoted restenosis figures almost in the 30-40% range. It is worth noting that there were only 124 stents implanted.
I find the article and the editorial comment interesting, and it does give food for thought.