title: Fighting restenosis after coronary angioplasty: contemporary and future treatment options.
abstract: Despite the widespread use of coronary stents, prevention of restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. The restenotic process is even higher after balloon angioplasty without stenting and has been shown to be in the range of 30-50%. Experimental data suggest that 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors ("statins") might have a beneficial effect on restenosis after coronary angioplasty. Proposed mechanisms include favorable effects on plasma lipoproteins, endothelial function, plaque architecture and stability, thrombosis and inflammation. Although statins have documented efficacy in reducing clinical events and angiographic disease progression in patients with coronary atherosclerosis, the results of subsequent large prospective clinical trials using different types of statins clearly demonstrate that statins do not have a short-to-medium term effect on prevention of restenosis after successful conventional PTCA. The underlying pathological reasons for this shortcoming as well as promising innovative approaches including gene therapy and local drug delivery of vasoactive substances will be discussed in this review.
authors.affiliation: Department of Cardiology, Heartcenter Wuppertal, University of Witten/Herdecke, Arrenberger Str. 20, 42117 Wuppertal, Germany. mhorlitz@hotmail.com
authors.forename: Marc
authors.initials: M
authors.lastname: Horlitz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sigwart
authors.forename: Josef
authors.initials: J
authors.lastname: Niebauer
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015607:Stents
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors