Drug-eluting stents Implications for modern coronary revascularization

Despite considerable data and years of experience in the field of coronary interventions and coronary surgery existing guidelines, which are still valid in the era of drug-eluting stents (DES), are often not followed. An increasing number of patients are treated with DES implantations against current recommendations. Due to antiplatelet therapy this impedes the planning and execution of additional invasive procedures that might be necessary after DES implantation and results in higher risks, if delaying treatment is not possible. As alternatives to stent implantation, coronary surgery nowadays offers a full range of individual treatment options which are highly effective and durable. They can be performed at low risk and do not interfere with subsequent invasive therapies. Patients suffering from relevant coronary artery disease and who are in need of additional invasive treatment should be considered for coronary surgery rather than stent implantation. If current guidelines are followed more closely, DES implantations and their accompanying drawbacks could be significantly reduced.