Vessel size is an important parameter with respect to adverse outcome after treatment with balloon angioplasty, stenting and drug eluting stents (DES). Coronary procedures in small vessel disease represent 30–50% of all cardiac interventions performed worldwide each year, with small vessel size being the strongest predictor of all risk factors for restenosis.1–4

After the advent of DES, the expected favourable results proved correct in larger vessels. Stenting, however, in small vessel disease proved to be problematic, and did not always produce the desired results.

Small vessel itself indicates a higher impact on restenosis than previously thought, due to the smaller vessel geometry, and the inability to accommodate neointimal tissue without compromising blood flow.5 Furthermore, after DES-stenting endothelialisation is attenuated as a consequence of the sustained release mode of the drug. Although stent thrombosis rates for newer generation DES are similar or even lower compared with bare metal stent (BMS),6 there remains the concern as to whether patients are able and/or willing to take dual antiplatelet therapy for at least 6 months. Thus, there remains a need for new strategies in the treatment of small vessel disease.

This takes us …