In patients with chronic renal insufficiency and global obstructive atherosclerotic renovascular disease, renal artery stenting improves or stabilizes renal function and preserves kidney size.

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Subclavian or brachiocephalic artery obstruction can be effectively treated by primary stenting or surgery. Comparison of stenting and the surgical experience demonstrates equal effectiveness but fewer complications and suggests that stenting should be considered as first line therapy for subclavian or brachiocephalic obstruction.

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ompared with balloon angioplasty, implantation of coronary stents has significantly decreased restenosis, 1-5 but in-stent restenosis caused by neointimal hyperplasia can occur in 20-30% of cases following bare metal stent implantation [6][7][8][9][10] and clinical in-stent restenosis or ischemia-driven revascularization for significant restenosis (≥50%) occurs in 10-15% following implantation of bare metal stents. This process usually occurs within 1 year of the index procedure and is believed to have a benign presentation with recurrent angina and/or evidence of ischemia on a stress test. However, there is scant data of an acute event such as myocardial infarction (MI) presenting as clinical in-stent restenosis. We sought to determine the incidence and type of MI, as well as clinical and angiographic characteristics of patients presenting with clinical instent restenosis (namely, any recurrent ischemia occurring in the stented segment) from our single center experience. Methods Study PatientsOf 2,462 consecutive patients who underwent percutaneous coronary interventions (PCI) with bare metal stents between June 2001 and December 2002, 212 (8.6%) were found to have clinical in-stent restenosis, which was defined as angiographic stenosis >50% within 5 mm of the stented segment for patients presenting for an angiogram for clinical evidence of ischemia (viz. angina or positive stress test). Patients presenting within 30 days of index procedure, with recurrent in-stent restenosis or restenosis following balloon angioplasty only, and patients presenting with MI clearly attributable to non-restenotic lesion or vessel were excluded. The antiplatelet regimen after the initial stent deployment was aspirin 325 mg daily indefinitely, and clopidogrel 75 mg daily for 4 weeks following a loading dose of 300 mg on the day of the procedure. The average follow-up period was 205±23 days (median 124 days). Based on the presenting symptoms and findings, the patients were divided into 3 groups: ST elevation MI (STEMI), non-ST elevation MI (NSTEMI), and non-MI groups. Patients with elevation of creatinine kinase (CK) 2-fold more than the normal reference with elevated MB fraction were considered to have a MI. Patients with STEMI were to have >1 mm ST-segment elevation in ≥2 contiguous leads. The NSTEMI group had elevated cardiac enzymes as above, without ST-segment elevation on the ECG. Renal failure was defined as baseline serum creatinine >2.0 mg/dl. The angiographic pattern of instent restenosis was analyzed as classified by Mehran et al. 11 Clinical and angiographic characteristics were compared among the 3 groups. Informed consent was given by each patient and the study protocol was approval by the institutional review board. Statistical AnalysisQuantitative data are presented as mean value ±1 SD or