John P. Reilly， MD， FACC， FSCAI
Ochsner Medical Center， New Orlean， US.

<International Circulation>: The coronary stent has been in clinical use for 10 to 15 years. In your opinion， what characteristics should an ideal stent have?

Prof. Reilly:The ideal stent would be a stent that could give good support and keep the artery open. It is very important initially to prevent abrupt occlusion of the artery， so that is the primary characteristic of a good stent. Stents have been plagued by restenosis. The ideal stents would have zero restonosis， currently drug eluting stents(DES) have made tremendous progress toward that objective， cutting that risk in half， now it’s single digit percentages， but not zero. So ideal stents should have no restenosis and will have no consequences for having zero restenosis. Also there are some concerns now about thrombosis， for the DES， there is very late thrombosis. So an ideal stent should have no thrombosis. And it may or may not have to be permamently implanted. There are some works going on the bio-absorbable stents， which hold the artery open and fade away. So that may be the solution to address the issue of restenosis and thrombosis.

<International Circulation>: You must have encountered no reflow or slow flow in intervention operations ， what do you do to prevent or solve these problems?

Prof. Reilly:The slow flow and no reflow occur after coronary intervention. We try to give vasodilator at the beginning of the operation， such as nitroprusside or calcium channel blockers like verapamil. Inject that through the guide catheter down to the bypass graft to try to open up microcirculation as much as possible. I don’t have any good data to support that， but it seems that this method helps. Once you get no reflow， that is very difficult to distally deliver nitroprusside or verapamil， but that is matter of time! The dosage of nitroprusside is 30~40mg one bolus and the concentration is 10mg in each milliliter.