Coronary artery restenosis: vascular biology and emerging therapeutic strategies.
Percutaneous coronary intervention with drug-eluting stents is currently the preferred approach to the treatment of obstructive coronary stenoses. Large, randomized trials have demonstrated a significant reduction in the incidence of restenosis after drug-eluting stent placement compared with balloon angioplasty or bare metal stents across a wide range of lesions. Furthermore, these stents have appeared to be effective in maintaining the luminal patency at follow up for up to 2-4 years. Concerns regarding the potential adverse effects of drug-eluting stents, such as aneurysm formation in arteries secondary to drug toxicity or hypersensitivity, as well as the overdependence on antiplatelet therapy for a protracted period to prevent subacute thrombosis, have been raised. However, evidence from large studies has not demonstrated any significant increase in the incidence of such adverse events. Future approaches to treating coronary stenoses involve technical modifications, such as direct stenting, accelerating endothelialization with gene delivery of nitric oxide donors, smooth muscle cell growth inhibitors after stent placement, biodegradable stents and concurrent use of local molecule delivery and oral chemotherapy. Ongoing large-scale postmarketing surveillance studies are expected to provide credible answers to the concerns regarding the safety of these stents.
Sarkar
Kunal
K
University of Arkansas for Medical Sciences, Division of Cardiovascular, 4301 West Markham Street, Slot 532, Little Rock, AR 72205, USA. Ksarkar@uams.edu
Sharma
Samin K
SK
Sachdeva
Rajesh
R
Romeo
Francesco
F
Garza
Luis
L
Mehta
Jawahar L
JL
D000818:Animals; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D001918:Brachytherapy; D002986:Clinical Trials as Topic; D023903:Coronary Restenosis / Q000473:pathology / Q000503:physiopathology* / Q000532:radiotherapy / Q000628:therapy; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D023822:Tissue Engineering
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus