Prevention of post-PTCA restenosis.
Significant improvements in the success of angioplasty combined with a major reduction in complications have led to widespread use of the technique in the treatment of symptomatic patients with coronary disease. Restenosis, however, remains the most significant limitation of angioplasty, occurring in 20-50% of patients following a successful procedure. Over the past 10 years, more than 40 large randomized pharmacological trials have attempted to address this problem. Currently no single agent has clearly been shown to reduce restenosis. As a consequence of intensive research, improved understanding of the pathophysiology of restenosis as well as the design of clinical studies necessary to study the process has resulted. Recent experimental studies suggest that vascular remodeling may be as important as intimal hyperplasia, and future trials will need to address this aspect of the restenosis process. Current approaches to preventing restenosis include the use of combined drug therapy to attack several pathophysiological processes, local delivery of drug at the site of the injury to maximize drug effect, and the use of highly specific drugs including local gene therapy.
Faxon
D P
DP
Department of Medicine, USC School of Medicine, Los Angeles 90033.
Currier
J W
JW
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery; D001792:Blood Platelets / Q000187:drug effects*; D002118:Calcium / Q000037:antagonists & inhibitors; D003078:Colchicine / Q000627:therapeutic use; D005395:Fish Oils / Q000627:therapeutic use; D006801:Humans; D008148:Lovastatin / Q000627:therapeutic use; D008981:Molsidomine / Q000627:therapeutic use; D009842:Oligopeptides / Q000627:therapeutic use; D010456:Peptides, Cyclic; D012008:Recurrence; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D005395:Fish Oils; D009842:Oligopeptides; D010456:Peptides, Cyclic; D013256:Steroids; C060347:lanreotide; D013004:Somatostatin; D008148:Lovastatin; D008981:Molsidomine; D003078:Colchicine; D002118:Calcium