Vascular restenosis - striving for therapy.
Restenosis is the limiting entity following coronary angioplasty. It is associated with significant morbidity, mortality and cost, and thus represents a major clinical and economical problem. Despite technical improvements, restenosis after conventional balloon angioplasty occurs in 30 - 60% of cases. Coronary stenting was able to reduce the incidence by approximately 30%; nevertheless, some 250,000 patients experience in-stent restenotic lesions/year worldwide. In-stent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50%, regardless of the angioplasty device used. So far, only vascular brachytherapy has convincingly reduced the incidence of repeat in-stent restenosis (by 50%) and thus, has emerged as the gold standard of therapy. The introduction of drug-eluting stents has shown a great deal of promise for the treatment of both de novo and restenotic lesions, with reported restenosis rates of < 10%, and benefit for virtually all patient subsets at a higher risk of restenosis. This review outlines the pathophysiology, epidemiology and predictors of the restenosis process, and places emphasis on the various treatment options for its prevention and therapy.
Schiele
Thomas M
TM
Ludwig-Maximilians-Universität München - Innenstadt, Department of Cardiology, University Hospital, Germany. Thomas.Schiele@medinn.med.uni-muenchen.de
Krötz
Florian
F
Klauss
Volker
V
D001918:Brachytherapy; D023903:Coronary Restenosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents
D017239:Paclitaxel; D020123:Sirolimus