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Apr 12, 2012

Treating Restenosis in Patients with Stents

Restenosis is the re-narrowing of the arteries after angioplasty. Comparing treatment options for restenosis shows that a drug-eluting stent is a safe and effective procedure.

Stenosis is the narrowing of a coronary artery due to the build-up of plaque on the walls of the artery. If untreated, stenosis can slow or block the flow of blood and cause a heart attack or stroke. Although there are many ways to treat stenosis, one of the most common is angioplasty—a minimally—invasive procedure that compresses plaque, restoring the flow of blood in a blocked coronary artery. During angioplasty, doctors often insert a drug-eluting stent that helps keep the artery open and prevent tissue from forming around the area of concern. This procedure is extremely safe and effective for many patients, often offering a permanent fix for narrowed arteries when paired with healthier lifestyle habits.

However, a small portion of patients treated with angioplasty and drug-eluting stents may experience restenosis, or re-narrowing of the affected site. Restenosis often occurs within 3-6 months of angioplasty and can be difficult to fix. Not only has the affected artery sustained trauma from the first procedure, making subsequent procedures more difficult, patients with restenosis are more likely to experience re-narrowing of the arteries again in the future.

So how can doctors effectively and safely treat restenosis? General guidelines exist around treatment options, but a study published by the Journal of the American College of Cardiology may help provide doctors with some much-needed information on best practices. In this study, researchers identified a total of 162 patients with drug-eluting stents and restenosis and randomized them to different treatments, either balloon cutting angioplasty or repeat implantation of one of two types of drug-eluting stents: sirolimus-eluting stents (SES) and everolimus-eluting stent (EES). After analysis, researchers found that for patients with a specific area of blockage, repeat implantation of SES is more effective than cutting balloon angioplasty. And among those with blockage over a larger area, implantation of SES and EES were equally as effective.

Although more research is needed to better understand the treatment of restenosis, this study adds to the growing body of evidence on the topic. Treating restenosis is complicated, and the fact that the condition is rare limits the ability of experts to research it adequately. But through additional research and the use of current guidelines, doctors can help guide patients toward the safest and most effective options and ultimately improve patient outcomes.

Read this Article in the Journal of the American College of Cardiology.

Questions for You to Consider

  • How many patients undergoing angioplasty experience restenosis?

  • Before angioplasty became more common, as many as half of patients undergoing this procedure may have experienced restenosis. However, through gained experience and the use of stents, as few as 10% of patients may experience re-narrowing of the arteries once treated.
  • How do drug-eluting stents differ from other types of stents?

  • The two main types of stents—bare-metal stents and drug-eluting stents—perform the same function of keeping the artery open and preventing it from collapsing. However, drug-eluting stents have the added function of preventing clots and tissue from forming around the stent by releasing medication.

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