Current Understanding of In-stent Restenosis and the Potential Benefit of Drug Eluting Stents

Abstract

Percutaneous transluminal coronary angioplasty has revolutionized the management of patients with coronary artery disease. Unfortunately, the procedure's utility is limited by a frequent complication: restenosis. Coronary stenting prevents the elastic recoil and negative remodeling that can occur after angioplasty but, by inciting varying degrees of intimal expansion, it can also produce arterial renarrowing, known as in-stent restenosis (ISR). The precise mechanisms involved in the pathogenesis of ISR are incompletely understood. The recent introduction of drug-eluting stents (DESs) may help prevent ISR. However, DESs have not been universally successful, and they may introduce new complications that require further refinement. This review summarizes the current understanding of the pathogenesis of ISR and provides an objective overview of DESs.

PPARα inhibits vascular smooth muscle cell proliferation underlying intimal hyperplasia by inducing the tumor suppressor p16INK4a

“…However, a potential risk of late thrombus formation associated with incomplete reendothelialization after surgery with these coated stents exists (50). It is noteworthy that, in our mouse model of restenosis, reendothelialization was completed 3 weeks after injury for all studied groups (Supplemental Figure 3).…”

“…Recently, substantial progress has been made in the prevention of restenosis, notably with the development of stents coated with antimitotic drugs, such as rapamycin (50). However, a potential risk of late thrombus formation associated with incomplete reendothelialization after surgery with these coated stents exists (50).…”

Comparison of Processing and Sectioning Methodologies for Arteries Containing Metallic Stents

“…Please visit this article online to view these materials. (J Histochem Cytochem 54:673-681, 2006) K E Y W O R D S stent artery restenosis methyl methacrylate resin immunohistochemistry THE PAST DECADE has witnessed a marked increase in the use of stents for the treatment of obstructive vascular disease (Froeschl et al 2004). Stents are metallic scaffolds that are inserted on a balloon catheter into a blood vessel and, with balloon expansion, are deployed against the vessel wall to restore patency (Supplemental Figure 1).…”

“…Therefore, attenuating the frequency of ISR remains an important goal of vascular interventional research. Unfortunately, our understanding of the arterial reaction to stent implantation is incomplete-primarily due to technical limitations in the histological study of stented vascular tissue (Froeschl et al 2004). Conventional paraffin embedding and sectioning procedures have demonstrated limitations with regard to their application to the histological study of the vascular effects of endovascular stent implantation.…”

Rôle protecteur de la voie fibrates/p16INK4Adans les lesions vasculaires occlusives

“…Elle intervient aussi dans la survenue de complications après des procédures médicales pour traiter la maladie, telles que la resténose-occlusion secondaire à une angioplastie transluminale avec ou sans mise en place d'une prothèse endocoronaire (stent) -et la vasculopathie du greffon lors d'un pontage veineux [3]. La resténose survient chez 30 % à 50 % des patients après une intervention coronarienne percutanée, et 20 % d'entre eux devront subir d'autres interventions, par exemple un pontage, lui-même limité par le risque de rejet de la greffe veineuse à la suite de l'obstruction luminale [4]. L'activation des CML induit leur changement phénotypique, qui est associé à une altération des mécanismes contrôlant le [5].…”