Percutaneous coronary intervention in small coronary vessels: from balloon angioplasty to drug eluting stent era.

Small vessel (< 3 mm) coronary artery disease is common and has been identified as independent predictor of restenosis after percutaneous coronary intervention. It remains controversial whether bare metal stent (BMS) implantation in small vessels has an advantage over balloon angioplasty in terms of angiographic and clinical outcomes. Introduction of drug-eluting stent (DES) has resulted in significant reduction in restenosis and the need for repeat revascularisation. Several DESs have been introduced resulting in varying reduction in outcomes as compared to BMS. However, their impact on outcomes in small vessels is not clearly known. It is expected that DES could substantially reduce restenosis in smaller vessels. Large, randomised studies are warranted to assess the impact of different DES on outcomes in patients with small coronary arteries.