Restenosis following coronary angioplasty
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Coronary restenosis
The high prevalence of restenosis is considered as a main problem concerning transluminal coronary angioplasty--known and popular invasive method of treatment of coronary heart disease. Mechanisms responsible for vascular wall healing and--also--restenosis as well as the role of cells and its mediators are discussed. The prevention of restenosis is a big challenge for contemporary medicine. The investigations concerning methods which theoretically seem to be justified are being conducted. Unfortunately the results of many trials are unconvincing. At present the most important ways of prevention of restenosis are stent implantation and antiplatelet drugs.
Coronary restenosis
Coronary disease
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Intracoronary artery radiation can significantly reduce restenosis rates after angioplasty, according to a new report (Circulation 2000;101:350-1,360-5).
Angioplasty is often complicated by restenosis, or coronary artery renarrowing. An estimated 30-50% of vessels dilated by angioplasty develop restenosis, a process that seriously limits the efficacy of the procedure. Restenosis can occur early or late after angioplasty and is heralded by symptoms of recurrent angina or even by myocardial infarct.
Restenosis is a consequence of the blood vessel wall responding to the “injury” of angioplasty and can thus be …
Coronary arteries
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Coronary restenosis
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The records of 1162 consecutive patients undergoing their first percutaneous transluminal coronary angioplasty at a centre between March 1980 and June 1987 were reviewed. Initial angioplasty was successful in 1011 patients (87%). In 202 (20%) symptomatic restenosis developed. Of these, 196 were treated with redilatation; this was successful in 181 (92%). After a second dilatation, restenosis developed in 47 patients (26%). Of these, 41 (87%) were treated with a third angioplasty, with primary success in 38 (93%). A further restenosis developed in 13 of these 38 patients (34%). Eight patients were treated with a fourth angioplasty with restenosis in four (50%). Two of these four patients underwent a fifth angioplasty (with continuing success at long term follow up in both). Overall, 14 of the 47 (30%) patients who developed restenosis twice were eventually treated with coronary bypass surgery. Most patients (33), however, were treated only with repeated angioplasties. Of these 33 patients, 27 were treated with a third angioplasty, four with a fourth procedure, and two with a fifth. Twenty-nine (88%) were symptom free at a mean follow up of 28 (range 8 to 86) months. The combined success rate for a third, fourth, and fifth angioplasty was 94%. These data suggest that most patients with recurrent restenosis after angioplasty may be managed successfully and safely with repeated redilatations.
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Atherectomy
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Despite widespread use of coronary balloon angioplasty, advances in angioplasty technology, and improvements in operator technique, restenosis at the angioplasty site is the major problem limiting the long-term efficacy of this procedure. The article reviews morphologic-histologic observations at angioplasty restenosis sites, speculates about the connection between the acute injury patterns of balloon angioplasty and the development of restenosis, and briefly reviews the currently understood pathways to restenosis and possible approaches to its reduction or elimination.
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Intimal hyperplasia
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Abstract In order to compare the processes of restenosis after balloon angioplasty as compared to that after directional coronary atherectomy, we performed qualitative and quantitative analysis of 72 lesions in 68 patients with recurrent ischemia following a successful initial procedure. For each lesion, we reviewed the pre‐intervention, immediate post‐intervention, and restenosis angiograms. The morphology of the restenotic lesions could not be predicted from pre‐ or post‐intervention angiograms. The restenotic lesions after directional atherectomy, as compared to balloon angioplasty, did not show a statistically significant difference, although there was a trend to more eccentric narrowing. © 1995 Wiley‐Liss, Inc.
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Restenosis is a major clinical problem following successful percutaneous transluminal angioplasty.Recent experimental evidence indicates that magnesium may have positive effect on restenosis in many ways.This context is a summary about the therapeutic effect,mechanism of action and unsolved questions of magnesium on restenosis on percutaneous transluminal angioplasty.
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