title: Vascular restenosis - striving for therapy.
abstract: 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.
authors.affiliation: Ludwig-Maximilians-Universität München - Innenstadt, Department of Cardiology, University Hospital, Germany. Thomas.Schiele@medinn.med.uni-muenchen.de
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schiele
authors.forename: Florian
authors.initials: F
authors.lastname: Krötz
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
mesh_terms: 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
chemical_list: D017239:Paclitaxel; D020123:Sirolimus