Lesion preparation prior to stenting.

Lesion preparation before stent implantation remains an essential component of the contemporary practice of coronary stent implantation in patients with long lesions, ostial lesions, chronic total occlusions, bifurcations, and calcified or nondilatable lesions. The goal of lesion preparation in these patients is to facilitate stent delivery, reduce plaque shift, and allow optimal stent expansion. Several procedures and second-generation devices have been proposed to achieve this goal, such as directional coronary atherectomy, rotational atherectomy, the cutting balloon, and the FX miniRAIL catheter. Even with the advent of drug-eluting stents, theoretically there are several reasons that aggressive lesion preparation would still be beneficial in selected patient subsets.