Treatment of Restenosis.
Restenosis constitutes the major limitation to the effectiveness of percutaneous coronary intervention. The advent of stent placement has engendered an even more difficult-to-treat entity: in-stent restenosis. Restenosis should be treated with repeat balloon angioplasty. Some patients with focal restenosis in large caliber vessels benefit from stent implantation. In the setting of diffuse in-stent restenosis, debulking techniques such as rotational atherectomy have been considered, but proof of efficacy is lacking. Despite a favorable acute procedural outcome, restenosis after repeat angioplasty develops in 32% to 37% of the treated patients. Therefore, combatting restenosis should focus on prevention. Intracoronary brachytherapy and drug- eluting stents have emerged as promising new tools to help prevent the development of restenosis.
Togni
Mario
M
Swiss Cardiovascular Center Bern, University Hospital, 3010 Bern, Switzerland. bernhard.meier@insel.ch
Windecker
Stephan
S
Meier
Bernhard
B