Seminars in Cardiothoracic and Vascular Anesthesia

 

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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 7, No. 3, 281-293 (2003)
DOI: 10.1177/108925320300700305

Evolving Strategies for the Prevention and Treatment of Coronary Restenosis

Sandra V. Dee, MD

Habib Samady, MD, FACC

Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia

Percutaneous coronary intervention has become an increasingly attractive alternative to medical therapy and surgical revascularization for the treatment of coronary artery disease. Over 1.5 million interventional procedures are performed annually worldwide, with the rate of procedures performed continuing to rise dramatically. Restenosis following percutaneous coronary intervention occurs at rates of 20% to 40% and has remained the Achilles heel of the procedure. Numerous early attempts at the prevention of restenosis with oral pharmacologic agents, such as antithrombotic therapies, lipid lowering agents, vasodilators, and growth factor inhibitors, failed to show benefit in clinical trials. The introduction of intracoronary stents resulted in a 30% reduction in restenosis rates by abolishing the early vessel recoil following angioplasty. However, as more complex lesions underwent percutaneous coronary intervention with stenting, rates of "in-stent" restenosis remained high (20% to 30%). With technologic advances and greater understanding of vascular pathobiology, novel therapeutic strategies, such as local delivery of ionizing radiation, immunosuppressive agents, and gene therapy, have been deployed to prevent coronary restenosis. In addition, a number of mechanical and radiation-based strategies have been used to treat those patients who develop restenosis. This review considers these emerging strategies for the prevention and treatment of restenosis.


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