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J Am Coll Cardiol, 2004; 44:1373-1385, doi:10.1016/j.jacc.2004.04.060
© 2004 by the American College of Cardiology Foundation
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CLINICAL TRIALS: VIEWPOINT

Preclinical restenosis models and drug-eluting stents

Still important, still much to learn

Robert S. Schwartz, MD, FACC*,{dagger},*, Nicolas A. Chronos, MBBS{ddagger} and Renu Virmani, MD§

* Minneapolis Heart Institute
{dagger} Minnesota Cardiovascular Research Institute, Minneapolis, Minnesota
{ddagger} American Cardiovascular Research Institute, Atlanta, Georgia
§ Armed Forces Institute of Pathology, Bethesda, Maryland

Manuscript received January 26, 2004; revised manuscript received March 28, 2004, accepted April 6, 2004.

* Reprint requests and correspondence: Dr. Robert S. Schwartz, Minneapolis Heart Institute, Minnesota Cardiovascular Research Institute, 920 East 28th Street, Suite 300, Minneapolis, Minnesota 55407 (Email: rss{at}rsschwartz.com).

Percutaneous coronary intervention continues to revolutionize the treatment of coronary atherosclerosis. Restenosis remains a significant problem but may at last be yielding to technologic advances. The examination of neointimal hyperplasia in injured animal artery models has helped in our understanding of angioplasty and stenting mechanisms, and as drug-eluting stent (DES) technologies have arrived, they too have been advanced through the study of animal models.These models are useful for predicting adverse clinical outcomes in patients with DESs because suboptimal animal model studies typically lead to problematic human trials. Similarly, stent thrombosis in animal models suggests stent thrombogenicity in human patients. Equivocal animal model results at six or nine months occasionally have been mirrored by excellent clinical outcomes in patients. The causes of such disparities are unclear but may result from differing methods, including less injury severity than originally described in the models. Ongoing research into animal models will reconcile apparent differences with clinical trials and advance our understanding of how to apply animal models to clinical stenting in the era of DESs.

Abbreviations and Acronyms
  DES = drug-eluting stent
  IVUS = intravascular ultrasonography
  MLD = minimum lumen diameter
  PRESTO = Prevention of REStenosis with Tranilast and its Outcomes trial




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Copyright © 2004 by the American College of Cardiology Foundation.