Intracoronary stenting. From concept to custom.

When Charles Stent, a 19th century English dentist, developed a mold with which to form an impression of the teeth and oral cavity, he would never have imagined that his name would become synonymous with the management of obstructive vascular disease, in particular coronary artery disease (Fig 1⇓).1 The term “stent” became associated with a device that held a skin graft in position, a support for tubular structures that were being anastomosed, and, more recently, an endovascular scaffolding to relieve and prevent vascular obstructions. Figure 1. Charles Stent (1845-1901), an English dentist who lent his name to a tooth mold (bottom) and more recently to endoluminal scaffolding devices. The management of coronary atherosclerosis has shifted from “masterly inactivity” to medical therapy, coronary bypass surgery, and, more recently, percutaneous techniques introduced by Gruentzig et al in 1977.2 Intracoronary stenting with continuing refinements appears poised to become the mainstay of the mechanical treatment of obstructive coronary disease. In his 1912 Nobel lecture, laureate Alexis Carrel described experiments with glass and metal tubes covered with paraffin that were introduced into canine thoracic aortae. Coagulation did not occur provided the aortic wall was not ulcerated, with one animal surviving for 90 days with a glass tube. He concluded that the presence of foreign bodies within vessels did not necessarily produce thrombus. The concept of using an implantable prosthetic device to maintain the luminal integrity of diseased vessels was reintroduced by Charles Dotter in 1964, when he suggested that the temporary use of a silicone elastomer endovascular splint could maintain an adequate lumen after the creation of a pathway in a previously occluded vessel.3 In 1969, he reported the results of the nonsurgical endarterial placement of spiral springs, mounted coaxially on a guidewire and positioned with a pusher catheter in the femoral …