Skip to main content
Springer Nature Link
Log in

Treatment options for coronary stent restenosis

  • Original Article
  • Published:
Comprehensive Therapy

Abstract

Treatment of in-stent restenosis with balloon angioplasty alone is adequate for focal lesions but is associated with a 50% recurrence rate for diffuse lesions. For diffuse in-stent restenosis, debulking with atherectomy or laser can significantly reduce the recurrence rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Sigwart U, Puel J, Mirkovitch V, et al. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.N Engl J Med. 1987;316:701–706.

    PubMed  CAS  Google Scholar 

  2. Bertrand ME, Legrand V, Boland J, et al. Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting: the full anticoagulation versus aspirin and ticlopidine (FANTASTIC) study.Circulation. 1998;98:1597–1603.

    PubMed  CAS  Google Scholar 

  3. Colombo A, Hall P, Nakamura S, et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance.Circulation. 1995;91:1676–1688.

    PubMed  CAS  Google Scholar 

  4. Fischman DL, Leon MB, Baim DS, et al for Stent Restenosis Study Investigators. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease.N Engl J Med. 1994;331:496–501.

    Article  PubMed  CAS  Google Scholar 

  5. Serruys P, de Jaegere WP, Kiemeneij F, et al for Benestent Study Group. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease.N Engl J Med. 1994;331:489–495.

    Article  PubMed  CAS  Google Scholar 

  6. Savage MP, Douglas JS Jr, Fischman DL, et al for Saphenous Vein De Novo Trial Investigators. Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts.N Engl J Med. 1997;337:740–747.

    Article  PubMed  CAS  Google Scholar 

  7. Sirnes PA, Golf S, Myreng Y, et al. Sustained benefit of stenting chronic coronary occlusion: long-term clinical follow-up of the Stenting in Chronic Coronary Occlusion (SICCO) study.J Am Coll Cardiol. 1998;32:305–310.

    Article  PubMed  CAS  Google Scholar 

  8. Antoniucci D, Santoro GM, Bolognese L, et al. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.J Am Coll Cardiol. 1998;31:1234–1239.

    Article  PubMed  CAS  Google Scholar 

  9. Kastrati A, Schomig A, Elezi S, et al. Predictive factors of restenosis after coronary stent placement.J Am Coll Cardiol. 1997;30:1428–1436.

    Article  PubMed  CAS  Google Scholar 

  10. Versaci F, Gaspardone A, Tomai F, et al. A comparison of coronary-artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery.N Engl J Med. 1997;336:817–22.

    Article  PubMed  CAS  Google Scholar 

  11. Serruys PW, van Hout B, Bonnier H, et al. Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II).Lancet. 1998;352:673–681.

    Article  PubMed  CAS  Google Scholar 

  12. Gordon PC, Gibson CM, Cohen DJ, et al. Mechanisms of restenosis and redilation within coronary stents—quantitative angiographic assessment.J Am Coll Cardiol. 1993;21:1166–1174.

    PubMed  CAS  Google Scholar 

  13. Painter JA, Mintz GS, Wong SC, et al. Serial intravascular ultrasound studies fail to show evidence of chronic Palmaz-Schatz stent recoil.Am J Cardiol. 1995;75:398–400.

    Article  PubMed  CAS  Google Scholar 

  14. Mintz GS, Kent KM, Pichard AD, et al. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: an intravascular ultrasound study.Circulation. 1997;95:1791–1798.

    PubMed  CAS  Google Scholar 

  15. Kimura T, Kaburagi S, Tamura T, et al. Remodeling of human coronary arteries undergoing coronary angioplasty or atherectomy.Circulation. 1997;96:475–483.

    PubMed  CAS  Google Scholar 

  16. Kimura T, Nosaka H, Yokoi H, et al. Serial angiographic follow-up after Palmaz-Schatz stent implantation: comparison with conventional balloon angioplasty.J Am Coll Cardiol. 1993;21:1557–1563.

    PubMed  CAS  Google Scholar 

  17. Laham RJ, Carrozza JP, Berger C, et al. Long-term (4-to 6- year) outcome of Palmaz-Schatz stenting: paucity of late clinical stent-related problems.J Am Coll Cardiol. 1996;28:820–826.

    Article  PubMed  CAS  Google Scholar 

  18. Schwartz RS, Murphy JG, Edwards WD, et al. Restenosis after balloon angioplasty: a practical proliferative model in porcine coronary arteries.Circulation. 1990;82:2190–2200.

    PubMed  CAS  Google Scholar 

  19. Ueda Y, Nanto S, Komamura K, et al. Neointimal coverage of stents in human coronary arteries observed by angioscopy.J Am Coll Cardiol. 1994;23:341–346.

    PubMed  CAS  Google Scholar 

  20. Kuntz RE, Gibson CM, Nobuyoshi M, et al. Generalized model of restenosis after conventional balloon angioplasty, stenting and directional atherectomy.J Am Coll Cardiol. 1993;21:15–25.

    PubMed  CAS  Google Scholar 

  21. Gordon PC, Friedrich SP, Piana RN, et al. Is 40% to 70% diameter narrowing at the site of previous stenting or directional coronary atherectomy clinically significant?Am J Cardiol. 1994;74:26–32.

    Article  PubMed  CAS  Google Scholar 

  22. Libby P, Schoenbeck U, Mach F, et al. Current concepts in cardiovascular pathology: the role of LDL cholesterol in plaque rupture and stabilization.Am J Med. 1998;104:14S-18S.

    Article  PubMed  CAS  Google Scholar 

  23. Chesebro JH, Rauch U, Fuster V, et al. Pathogenesis of thrombosis in coronary artery disease.Haemostasis. 1997;27(suppl 1):12–18.

    PubMed  CAS  Google Scholar 

  24. Baim DS, Levine MJ, Leon MB, et al for the U.S. Palmaz-Schatz Stent Investigators. Management of restenosis within the Palmaz-Schatz coronary stent: the U.S. multicenter experience.Am J Cardiol. 1993;71:364–366.

    Article  PubMed  CAS  Google Scholar 

  25. Eltchaninoff H, Koning R, Tron C, et al. Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate.J Am Coll Cardiol. 1998;32:980–984.

    Article  PubMed  CAS  Google Scholar 

  26. Mehran R, Mintz GS, Popma JJ, et al. Mechanisms and results of balloon angioplasty for the treatment of in-stent restenosis.Am J Cardiol. 1996;78:618–622.

    Article  PubMed  CAS  Google Scholar 

  27. Bauters C, Banos JL, Van Belle E, et al. Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis.Circulation. 1998;97:318–321.

    PubMed  CAS  Google Scholar 

  28. Reimers B, Moussa I, Akiyama T, et al. Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis.J Am Coll Cardiol. 1997;30:186–192.

    Article  PubMed  CAS  Google Scholar 

  29. Yokoi H, Kimura T, Nakagawa Y, et al. Long-term clinical and quantitative angiographic follow-up after the Palmaz-Schatz stent restenosis.J Am Coll Cardiol. 1996;27(suppl):224A.

    Google Scholar 

  30. Dauerman HL, Baim DS, Cutlip DE, et al. Mechanical debulking versus balloon angioplasty for the treatment of diffuse in-stent restenosis.Am J Cardiol. 1998;82:277–284.

    Article  PubMed  CAS  Google Scholar 

  31. Shiran A, Mintz GS, Waksman R, et al. Early lumen loss after treatment of in-stent restenosis: an intravascular ultra-sound study.Circulation. 1998;98:200–203.

    PubMed  CAS  Google Scholar 

  32. Ahn SS, Auth D, Marcus DR, et al. Removal of focal atheromatous lesions by angioscopically guided high-speed rotary atherectomy: preliminary experimental observations.J Vasc Surg. 1988;7:292–300.

    Article  PubMed  CAS  Google Scholar 

  33. Lee SG, Lee CW, Cheong SS, et al. Immediate and long-term outcomes of rotational atherectomy versus balloon angioplasty alone for treatment of diffuse in-stent restenosis.Am J Cardiol. 1998;82:140–143.

    Article  PubMed  CAS  Google Scholar 

  34. Strauss BH, Umans VA, van Suylen RJ, et al. Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic and histologic results.J Am Coll Cardiol. 1992;20:1465–1473.

    Article  PubMed  CAS  Google Scholar 

  35. Mehran R, Mintz GS, Satler LF, et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty: mechanisms and results compared with PTCA alone.Circulation. 1997;96:2183–2189.

    PubMed  CAS  Google Scholar 

  36. Koster R, Hamm CW, Terres W, et al. Treatment of in-stent coronary restenosis by excimer laser angioplasty.Am J Cardiol. 1997;80:1424–1428.

    Article  PubMed  CAS  Google Scholar 

  37. Goldberg SL, Berger PB, Cohen DJ, et al. Balloon angioplasty versus rotational atherectomy for in-stent restenosis [abstract].Circulation. 1998;98:I363.

    Google Scholar 

  38. Sharma S, Skini A, Duvvuri S, et al. Randomized Trial of Rotational Atherectomy vs Balloon Angioplasty for In-Stent Restenosis (ROSTER) [abstract].Circulation. 1998;98:I434.

    Google Scholar 

  39. Chevalier B, Glatt B, Guyon P, Royer P. In stent restenosis treated with systematic secondary coronary stenting [abstract].Circulation. 1998;98:I434.

    Google Scholar 

  40. Inoue N, Miyao K, Tokura T, et al. Is stenting in stent for treatment of in-stent restenosis an acceptable strategy [abstract]?Circulation. 1998;98:I434.

    Google Scholar 

  41. Teirstein PS, Massullo V, Jani S, et al. Catheter-based radiotherapy to inhibit restenosis after coronary stenting.N Engl J Med. 1997;336:1697–1703.

    Article  PubMed  CAS  Google Scholar 

  42. Waksman R, White LR, Chan RC, et al. Intracoronary radiation therapy for patients with in-stent restenosis [abstract].Circulation. 1998;98:I434.

    Google Scholar 

  43. King SB III, Williams DO, Chougule P, et al. Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty: results of the Beta Energy Restenosis Trial (BERT).Circulation. 1998;97:2025–2030.

    PubMed  Google Scholar 

  44. Verin V, Urban P, Popowski Y, et al. Feasibility of intracoronary beta-irradiation to reduce restenosis after balloon angioplasty: a clinical pilot study.Circulation. 1997;95:1138–1144.

    PubMed  CAS  Google Scholar 

  45. Teirstein P. Beta-radiation to reduce restenosis: too little, too soon? [editorial].Circulation. 1997;95:1095–1097.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Massachusetts-Memorial, USA

    Harold L. Dauerman MD

  2. Medical Center, University of Massachusetts Medical School, Worcester, Mass

    Harold L. Dauerman MD

  3. Division of Cardiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Mass

    David J. Cohen MD, MSc

Authors
  1. Harold L. Dauerman MD
    View author publications

    Search author on:PubMed Google Scholar

  2. David J. Cohen MD, MSc
    View author publications

    Search author on:PubMed Google Scholar

About this article

Cite this article

Dauerman, H.L., Cohen, D.J. Treatment options for coronary stent restenosis. Compr Ther 25, 403–410 (1999). https://doi.org/10.1007/BF02944291

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02944291

Keywords