Angina pectoris: interventional therapies and treatment of restenosis.
Angina pectoris is a clinical syndrome of symptoms caused by myocardial ischaemia due to oxygen demand exceeding supply. The most common cause is coronary artery stenosis due to progressive atherosclerotic disease. Angina has a prevalence of approximately 5% and increases with age. Despite improvements in treatment there remains a yearly mortality of 2-3%. A major advance in the treatment of symptomatic angina was the introduction of percutaneous transluminal coronary angioplasty (PTCA). This initial enthusiasm was dampened by significant numbers developing symptomatic restenosis from vascular elastic recoil and neointimal hyperplasia (NI). The widespread introduction of stent deployment following the initial angioplasty reduced the rates of elastic recoil but failed to prevent NI and may actually stimulate it. Currently, there is much interest in mechanisms that alter cell proliferation thereby decreasing NI. Techniques include brachytherapy, photodynamic therapy and drug-eluting stents. Provisional data for these new stents, which slowly release medication that inhibits cell turnover, are very good with few occurrences of restenosis. Results from larger randomised trials are awaited.
Nair
Sunil V
SV
Centre for Cardiovascular Biology and Medicine, BHF Laboratories, Rayne Building, WC1E 6JJ London, UK.
McEwan
Jean R
JR
D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000628:therapy; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008134:Long-Term Care; D008954:Models, Biological; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects
D003692:Delayed-Action Preparations; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors