New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima?

Mario, Carlo Di; Marsico, Federica; Adamian, Milena; Karvouni, Evangelia; Albiero, Remo; Colombo, Antonio

doi:10.1136/heart.84.5.471

Cited by 28 publications

(30 citation statements)

References 36 publications

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“…23,24 However, no large or randomized studies have been conducted and general usage of brachytherapy is limited by lack of availability in the USA, as well as the high expense and necessary collaboration with several non-cardiology specialists. 17,26 More recently, DES have shown promise in addressing high restenosis rates. Granillo et al reported a case of complex bilateral RAS, involving the bifurcation, successfully treated with Paclitaxeleluting stents.…”

Section: Discussionmentioning

confidence: 99%

“…The microsurgical blades can cut to the metal stent cage, which protects the arterial wall. 17,18 The microblades provide several advantages over conventional PTRA: they anchor the balloon, disrupt the fibroelastic continuity of the neointimal hyperplasia, and induce a fault line for plaque. A study of CBA use in restenosed coronary arteries found CBA to be superior to standard angioplasty and roughly as effective as more expensive atheroablation.…”

Section: Discussionmentioning

confidence: 99%

“…11 Recurrent ISR, however, remains a significant problem for many patients. Creating a 'stent-sandwich', by placing a second stent within the original stent, stretches the wall of the artery and further stimulates myointimal hyperplasia, 17 leading to longterm failure of the stent and the necessity of repeated intervention. Consequently, research today has largely shifted to the prevention and management of restenosis.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous revascularization of persistent renal artery in-stent restenosis

et al. 2009

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Percutaneous renal artery stenting is a common means of treating atherosclerotic renal artery stenosis. However, renal artery restenosis remains a frequent problem. The optimal treatment of restenosis has not been established and may involve percutaneous renal artery angioplasty or deployment of a second stent. Other modalities include cutting balloon angioplasty, repeat stenting with drug-eluting stents or endovascular brachytherapy. Most recently, use of polytetrafluoroethylene (PTFE)-covered stents may offer a new and innovative way to treat recurrent renal artery stenosis. We describe a case in a patient who initially presented with renal insufficiency and multi-drug hypertension in the setting of severe bilateral renal artery stenosis. Her renal artery stenosis was initially successfully treated by percutaneous deployment of bilateral bare metal renal artery stents. After initial improvement of her hypertension and renal insufficiency, both parameters declined and follow-up duplex evaluation confirmed renal artery in-stent restenosis. Owing to other medical co-morbidities she was felt to be a poor surgical candidate and was subsequently treated first with bilateral cutting balloon angioplasty and second with drug-eluting stent deployment. Each procedure was associated with initial improvement of renal function and blood pressure control, which then later deteriorated with the development of further significant in-stent restenosis. It was then decided to treat the restenosis using PTFE-covered stents. At 12 months of follow-up, the blood pressure had remained stable and renal function had normalized. The covered stents remained free of any significant neointimal tissue or obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Percutaneous revascularization of persistent renal artery in-stent restenosis

et al. 2009

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“…In-stent restenosis represents a major challenge in interventional cardiology and the optimal percutaneous revascularization strategy for the treatment of this disease remains debatable. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [12][13][14][15][16]. Since the mechanism of in-stent restenosis is predominantly intimal hyperplasia, debulking techniques may be more efficacious than balloon angioplasty [17,18].…”

Section: Introductionmentioning

confidence: 98%

Directional coronary atherectomy vs. rotational atherectomy for the treatment of in‐stent restenosis of native coronary arteries

Sánchez

Rodriguez-Alemparte

Colón-Hernández

et al. 2003

Cathet Cardio Intervent

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Management of in-stent restenosis has become a significant challenge in interventional cardiology. Since the mechanism of in-stent restenosis is predominantly intimal hyperplasia, debulking techniques have been used to treat this condition. This study is a nonrandomized comparison of the immediate and long-term results of directional coronary atherectomy (DCA; n = 58) vs. high-speed rotational atherectomy (ROTA; n = 61) for the treatment of in-stent restenosis of native coronary arteries. There were no in-hospital deaths, Q-wave myocardial infarctions, or emergency coronary artery bypass surgery in either group. DCA resulted in a larger postprocedural minimal luminal diameter of (2.57 +/- 0.51 vs. 2.14 +/- 0.37 mm; P < 0.0001) and a larger acute gain (1.83 +/- 0.52 vs. 1.42 +/- 0.48 mm; P < 0.0001). Furthermore, 12-month clinically indicated target lesion revascularization (39% vs. 21%; P = 0.02) and long-term follow-up MACE (44% vs. 28%; P = 0.03) was greater in the ROTA group. The present study suggests that DCA appears to be superior to ROTA for the treatment of in-stent restenosis of native coronary arteries. Compared to ROTA, the debulking effect of DCA leads to a larger postprocedure minimal luminal diameter, and a lower incidence of subsequent target lesion revascularization and MACE.

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“…22 Nevertheless, in-stent restenosis is often attributed to bare-metal stents having micron particle sizes that encourage neointimal tissue formation. [23][24][25] Additionally, the release of metal ions from the stent might increase local inflammation.…”

Section: Microporous and Microstructured Surfacesmentioning

confidence: 99%