The approach to small vessels in the era of drug-eluting stents

The treatment of small-vessel disease will occupy an increasingly important part of interventional cardiology practice and this raises several issues. The definition of "small vessels" has great implications for device size selection, and knowledge of "normal" small-vessel dimensions is important. Stents have been applied in the setting of smaller-vessel disease and future iterations of small-vessel stents will need to address several design factors. Stent strut thickness might impact on subsequent restenosis as well as late lumen loss. There has been great interest in the use of drug-eluting stents for small vessels. Randomized clinical trials of sirolimus-eluting versus bare metal stents in the treatment of small-vessel disease have shown significant improvements in the rates of target lesion revascularization and restenosis with sirolimus-eluting stents. These improvements in restenosis rates are attributable to the low levels of late loss with the drug-eluting stent.