Review
New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima?
C Di Marioa, F Marsicoa, M Adamianb, E Karvounib, R Albierob, A Colomboaa Department of
Interventional Cardiology, San Raffaele Hospital, Via Olgettina 60, 20140 Milan, Italy, b Department of Interventional Cardiology,
Columbus Clinic, Via Buonarroti G8, Milan, Italy
Correspondence to: Dr Di Mario dimario@micronet.it
Accepted 19 July
2000
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Introduction |
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In-stent
restenosis is set to become a large part of our interventional practice
in the new millennium. Stent implantation has grown so much that it now
comprises 60-70% of all percutaneous coronary revascularisation
interventions, and assuming a conservative 25% restenosis rate for a
total of around one million percutaneous transluminal coronary
angioplasty (PTCA) procedures this year, more than 150 000 lesions
will need treatment because of in-stent restenosis. The increasing
popularity of stent implantation is because of improvements in
immediate gain, in tackling dissections, in preventing recoil after
PTCA, and in reducing late restenoses, which have been documented in
many randomised trials where results have been compared with PTCA.
However, despite excellent immediate results, stents have not
eliminated restenosis, especially in complex lesions with diffuse
coronary disease or in small vessels.1-4 Furthermore, the
mechanism of in-stent restenosis is very different from that of
restenosis after conventional percutaneous treatment (PTCA,
directional, rotational,
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