Sections 1.2-1.4 of this guidance have been replaced by NICE technology appraisal guidance 152.
NICE has made the following recommendations about the use of stents in operations for coronary artery disease.
A stent should normally be used during balloon angioplasty in a person who has angina or has had a heart attack.
The decision on which type of stent to use should depend on the person?s symptoms, and on the size and shape of the narrowed part of the artery. A drug-eluting stent should be used if the person has angina, and the inside diameter of the artery is less than 3 mm across, or the narrowed area is more than 15 mm long. There are several different drug-eluting stents, which contain different drugs. NICE recommends stents that contain either a drug called sirolimus, or one called paclitaxel, because most of the research has been on these.
If more than one artery is narrowed, doctors should make the decision on which type of stent to use for each artery separately.
This guidance covers treatment for people who would normally be offered some form of balloon angioplasty. NICE has not made any recommendations on using stents to treat people who have had a heart attack in the previous 24 hours, or people who had a clot in the narrowed artery.
This guidance updates and replaces NICE technology appraisal guidance 4 (published in May 2000).
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.