Coronary Stenting Turns 40 in 2026. What Should We Know?

Ирэн Орлонская • 03.01.2026, 11:56 • Health

Memories and reflections of Professor Igor Pershukov on coronary stenting.

I.V. Pershukov – professor, doctor of medical sciences, head of the Department of Hospital Therapy with a course in Radiological Diagnostics and Oncology at Jalal-Abad State University.

In 1977, young physician Andreas Roland Grunzig revolutionized medicine by performing the first coronary angioplasty using a balloon made in his kitchen. This method allowed for the crushing of plaque in the coronary artery and restored normal blood flow, relieving the patient of angina and opening a new era in percutaneous interventions on coronary vessels.

Despite its effectiveness, the method faced challenges, the most common of which was restenosis – the re-narrowing of the vessel at the site of intervention. By creating high pressure to crush the plaque, doctors inadvertently contributed to the hypertrophy of the vessel wall, leading to restenosis in 40-50% of patients within six months after the procedure.

The search for solutions to this problem did not cease. Various technologies, such as drilling or cutting plaques, proved ineffective for all categories of patients.

American cardiologist Richard Alexander Schatz proposed an innovative solution by creating the first effective stent, the Palmaz-Schatz, which utilized a framework originally developed by Argentine physician Julio Palmaz for expanding bile ducts.

However, their fates could have been different had Schatz and Grunzig met as planned. Tragically, on the eve of their meeting, Grunzig died in a plane crash. The first stentings of coronary arteries were performed by other specialists: in March 1986, Jacques Puel conducted the implantation of a self-expanding stent in France, while Ulrich Sigwart presented the results of his work in Switzerland.

By the mid-90s, it became clear that only balloon-expandable stents, such as the Palmaz-Schatz, effectively reduced the level of restenosis, although they did not eliminate it completely. The frequency of restenosis decreased by 10-15%, which, despite the significance of this achievement, required further research.

In 1993, in the USA, coronary angioplasty began to rival the frequency of coronary bypass surgeries, and this occurred in Europe in 1994. Since then, percutaneous interventions have become more common due to their minimally invasive nature and rapid rehabilitation.

Research showed that stents should not remain in coronary arteries permanently. In the 90s, Japanese researchers proposed biodegradable stents made of magnesium and poly-L-lactate; however, their use revealed serious risks, such as late thrombosis.

A breakthrough occurred in the early 21st century when laboratories at Johnson & Johnson developed drug-eluting stents. The first of these was the Cypher stent, which used rapamycin and significantly reduced the level of restenosis by suppressing cell growth.

Modern stents have undergone several improvements and today have significantly higher performance characteristics. However, their use is associated with the risk of late and very late thrombosis, necessitating prolonged dual antithrombotic therapy. Currently, the rate of restenosis is less than 10% within the first year, while the risk of thrombosis varies but usually does not exceed 2%.

These achievements allow for an optimistic outlook for patients suffering from ischemic heart disease. The "stent for life" program initiated in Europe demonstrates its effectiveness in saving lives during acute myocardial infarctions.

There is hope that future developments will be less invasive and safer. However, while this remains only a hypothesis, it is important to recognize the significance of modern stents and the requirements associated with their use. This is the key to our health and well-being, ensured through stenting.

Perhaps in the future, these technologies will reach space and become as safe there as in the best medical institutions on Earth.

Take care of your health!

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