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In 1986, when pioneers such as Jacques Puel and Ulrich Sigwart implanted the first coronary Wallstents, no guidelines were available to determine the treatment after stenting. From the experience acquired with mechanical prosthetic heart valves, it was inferred that chronic anticoagulation with coumarins was indicated. When the first cases of subacute occlusion were encountered, the anticoagulation regimen was further reinforced. The use of heparin, dextran, or thrombolytic agents during the procedure followed by warfarin, aspirin, sulphinpyrazone, and dipyridamole did not eliminate subacute thrombosis, which occurred in 18% of the first 117 stents implanted and was responsible for a higher incidence of hemorrhagic complications and prolonged hospital stay.1 When the first Palmaz-Schatz stents were implanted in the coronary arteries, Richard Schatz initially claimed that the sole treatment with antiplatelet agents was sufficient to prevent subacute occlusion (panel discussion, European Society of Cardiology Congress, Vienna, 1988). Unfortunately, a prohibitive early occlusion rate (18%) was observed with this regimen, so a stringent anticoagulation regimen was again recommended.2 These two consecutive negative experiences identified coronary stents as highly thrombogenic foreign bodies and discouraged investigators from using coronary stenting as a primary treatment for coronary artery stenosis. Stenting was thus restricted to the treatment of acute complications after balloon angioplasty. It is to the merit of Antonio Colombo and his group to have broken this vicious circle and focused the attention of the community of interventional cardiologists on the modalities of stent deployment, questioning the dogma of the intrinsic thrombogenic nature of the stents. Early experience with subacute stent occlusion despite optimal anticoagulation convinced Colombo and his coworkers that the key issue in the prevention of subacute occlusion was not the perfect control of hemostasis but the optimization of stent implantation (panel discussion, Rotterdam Stent Course, December 1994). The major critical contribution of …

Who Was Thrombogenic: The Stent or the Doctor?