Renin-angiotensin system intervention to prevent in-stent restenosis: an unclosed chapter.
The occurrence of in-stent restenosis is a major drawback of percutaneous transluminal coronary angioplasty with stent placement. Target vessel revascularization is necessary in 15% of patients who receive a stent. Recent advances in the development of drug-eluting stents have reduced these numbers tremendously. However refinement of antirestenotic therapies remains obligatory. The emerging interest in more physiological antirestenotic therapies might unchain an interest in the well-known inhibitors of the rennin-angiotensin system (RAS), the angiotensin-converting enzyme inhibitors, and the angiotensin II type I receptor blockers. Contradictory results overshadow the discussion of whether intervention in the RAS could prevent in-stent restenosis. This review discusses the pathophysiology of in-stent restenosis, the role of the RAS in in-stent restenosis, and the possible role of RAS intervention in the prevention of in-stent restenosis.
Langeveld
Bas
B
Department of Clinical Pharmacology, University Hospital Groningen, Groningen, the Netherlands. be.langeveld@med.rug.nl
Roks
Anton J M
AJ
Tio
Rene A
RA
Voors
Adriaan A
AA
Zijlstra
Felix
F
van Gilst
Wiek H
WH
D000800:Angioplasty, Balloon / Q000009:adverse effects; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D002986:Clinical Trials as Topic; D023903:Coronary Restenosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D015607:Stents / Q000009:adverse effects*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors