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Ann Thorac Surg 2006;81:1918-1925
© 2006 The Society of Thoracic Surgeons

Review

Coronary Stenting and Inflammation: Implications for Further Surgical and Medical Treatment

Walter J. Gomes, MD, PhD * , Enio Buffolo, MD, PhD

Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil

Accepted for publication October 17, 2005.

* Address correspondence to Dr Gomes, Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu 740, São Paulo, SP 04023-900, Brazil (Email: wjgomes.dcir{at}epm.br).

The introduction of percutaneous coronary interventions (PCI) with stent implant has substantially shifted the treatment of coronary artery disease. The current approach to coronary artery disease treatment includes first-choice PCI in selected subgroups; and once this therapy fails, frequently the patient is referred for coronary artery bypass graft surgery. However, evidence of chronic inflammatory reaction and endothelial dysfunction after PCI has been emerging and that might be interfering with patient outcome when surgical or medical treatments are subsequently required. The clinical significance of these complications after PCI, herein examined, has been less studied and needs better assessment. Also, the premise that coronary artery bypass graft surgery can safely be performed in patients with coronary stenting failure may not hold true, as graft patency might be adversely affected. Furthermore, the superimposed inflammatory reaction may blunt the efficacy of medical treatment.




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