REVIEW ARTICLE
Coronary in-stent restenosis: Current status and future strategies
Harry C. Lowe, FRACP, PhD* ,
Stephen N. Oesterle, MD, FACC* and
Levon M. Khachigian, PhD,*
* Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
The Centre for Thrombosis and Vascular Research, University of New South Wales, Sydney, Australia
Manuscript received July 11, 2001;
revised manuscript received October 4, 2001,
accepted October 26, 2001.
* Reprint requests and correspondence: Associate Professor Levon M. Khachigian, Centre for Thrombosis and Vascular Research, School of Pathology, University of New South Wales, Sydney NSW 2052, Australia.
L.Khachigian{at}unsw.edu.au
In-stent restenosis (ISR) is a novel pathobiologic process, histologically distinct from restenosis after balloon angioplasty and comprised largely of neointima formation. As percutaneous coronary intervention increasingly involves the use of stents, ISR is also becoming correspondingly more frequent. In this review, we examine the available studies of the histology and pathogenesis of ISR, with particular reference to porcine and other animal models. An overview of mechanical treatments is then provided, which includes PTCA, directional coronary atherectomy and high speed rotational atherectomy. Radiation-based therapies are discussed, including a summary of current problems associated with this modality of treatment. Finally, novel strategies for the prevention of ISR are addressed, including novel developments in stents and stent coatings, conventional drugs, nucleic acid-based drugs and gene transfer. Until recently, limited pharmacologic and mechanical treatment options have been available for both treatment and prevention of ISR. However, recent advances in gene modification and gene transfer therapies and, more particularly, in local stent-based drug delivery systems make it conceivable that the incidence of ISR will now be seriously challenged.
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Abbreviations and Acronyms
| | ARTIST | | Angioplasty Versus Rotational Atherectomy for Treatment of In-Stent Restenosis trial | | AS | | antisense | | DCA | | directional coronary atherectomy | | DNA | | deoxyribonucleic acid | | DZ | | deoxyribonucleic acid enzyme | | HSRA | | high-speed rotational atherectomy | | Ir | | iridium | | ISR | | in-stent restenosis | | NI | | neointima | | P | | phosphorus | | PRESTO | | Prevention of Restenosis with Tranilast and its Outcomes trial | | PREVENT | | Proliferation Reduction with Vascular Energy Trial | | PTCA | | percutaneous transluminal coronary angioplasty | | RAVEL | | Rapamycin-eluting versus Plain Polymer Stents trial | | RNA | | ribonucleic acid | | ROSTER | | Randomized Trial of Rotational Atherectomy versus Balloon Angioplasty for In-Stent Restenosis | | RZ | | ribozyme | | SCRIPPS | | Scripps Coronary Radiation to Inhibit Proliferation Post Stenting trial | | SMC | | smooth muscle cell | | Sr-90 | | strontium90 | | START | | Stents And Radiation Therapy Trial | | WRIST | | Washington Radiation for In-Stent Restenosis Trial |
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