[Clinical, angiographic, and procedure factors predicting coronary restenosis after stent implantation: synthesis of the evidence].
Stent implantation is the only technique that has proven to reduce restenosis rate for selected lesion types after procedures of percutaneous coronary revascularization. Yet restenosis, although reduced, continues to exert a negative impact on long-term clinical outcome of treated patients. In-stent restenosis is almost exclusively due to neointimal hyperplasia, which appears more pronounced following stent than after other types of devices. A new revascularization procedure is clinically required in almost one half of the cases of in-stent restenosis; its angiographic pattern represents a major determinant of the efficacy of repeat intervention, a diffuse pattern being associated with a worse prognosis. The most powerful predictors of in-stent restenosis include diabetes mellitus, vessel caliber, cumulative stent length and its minimal lumen diameter after expansion; genetic variables and biological individual factors may also play an important role in conditioning the local response to stent placement. Intravascular ultrasound-guided stent deployment and the use of very high pressure to assure full stent expansion have not demonstrated to improve long-term clinical and angiographic results of the procedure. Some observational studies have suggested that plaque removal with directional or rotational atherectomy prior to stent implantation may reduce the risk of restenosis; the usefulness of this approach is currently evaluated in randomized clinical trials. Absence of restenosis has recently been reported in small pilot studies in which stents coated with antiproliferative drugs were used; these findings warrant further confirmation and represent one of the most promising issues for the next future.
Cavallini
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Dipartimento Cardiovascolare, Ospedale Regionale, Ca' Foncello, Treviso. clcaval@tin.it
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D005544:Forecasting; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D015607:Stents
Fattori clinici, angiografici e procedurali predittivi di restenosi coronarica dopo impianto di stent: sintesi delle evidenze.