Treatment of drug‐eluting stent restenosis: An emerging challenge

Abstract

Drug eluting stent (DES) restenosis has emerged as a significant clinical entity owing to the increasing use of DES in complex lesions and patients. However, to date, there is a paucity of studies that have addressed the management of DES restenosis and the resulting outcome, leaving the interventional cardiologist with a therapeutic dilemma. The purpose of this paper is therefore to provide a concise review of available data's dealing with the treatment of DES restenosis, including the outcome of patients treated for DES restenosis, the prognostic importance of the angiographic pattern and the available therapeutic modalities.

Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

“…[4][5][6] Therefore, we feel this study is likely to suggest that the prognosis of ISR after 2nd generation DES implantation might be better than that of 1st generation DES.…”

“…4,5) Moreover, the morphologic classification of DES ISR remains an important predictor of clinical outcomes after ISR treatment. [4][5][6] The newer DES, such as everolimus-eluting stents (EES) and Resolute zotarolimus-eluting stents (ZES), are characterized by improvements in stent platform, polymer, and drug, with the aim of minimizing the incidence of DES ISR and improving safety.7-10) However, the angiographic patterns of the new generation DES ISR have not been fully described yet. Thus, we analyzed the angiographic patterns of restenosis that occurred after DES implantation in our institution, and compared the morphologic patterns of the new generation DES ISR with those of 1st generation DES [sirolimus-(SES) and paclitaxel-eluting stents (PES)] ISR.…”

“…4,5) Moreover, the morphologic classification of DES ISR remains an important predictor of clinical outcomes after ISR treatment. [4][5][6] The newer DES, such as everolimus-eluting stents (EES) and Resolute zotarolimus-eluting stents (ZES), are characterized by improvements in stent platform, polymer, and drug, with the aim of minimizing the incidence of DES ISR and improving safety. [7][8][9][10] However, the angiographic patterns of the new generation DES ISR have not been fully described yet.…”

A novel three‐dimensional quantitative coronary angiography system: In‐vivo comparison with intravascular ultrasound for assessing arterial segment length

“…Despite the tremendous success of the procedure in the instant treatment of coronary artery diseases, a higher risk of restenosis due to the suboptimal stent selection and deployment has hampered the translation of the procedure success into long-term outcomes [17][18][19]. The drug-eluting stents (DES) have proven to be able to reduce the instent restenosis after the intervention [20][21][22]; however, the efficacy depends on complete lesion coverage, and therefore requires appropriate stent selection [17,23].…”

Magnetic nanoparticles for targeted vascular delivery

“…Stents initially used as mere metallic scaffolds physically preventing reocclusion of the vessel have been later reengineered to provide local delivery of antiproliferative drugs inhibiting the growth and migration of vascular smooth muscle cells triggered by arterial injury in the course of stent angioplasty. Although the therapeutic efficacy of drugs released to the arterial wall from the surface of a stent has been well established in patients with coronary artery disease or noncomplex vascular lesions, this approach has not been equally effective in the noncoronary vasculature and in complex settings with the observed frequency of recurrent stenosis often higher than 10% (28,29). Recent studies suggest that the suboptimal performance of drugeluting stents in these clinical settings is likely due to the inability to adjust the pharmacological effect of the drug to the timescale of the disease progression (30), which may vary considerably between different vessel types and as a result of additional risk factors, e.g., in diabetic patients.…”