Pathophysiology and pharmacological approaches for prevention of coronary artery restenosis following coronary artery balloon angioplasty and related procedures

doi:10.1016/S0033-0620(97)80034-5

Progress in Cardiovascular Diseases

Volume 39, Issue 4, January–February 1997, Pages 361-398

https://doi.org/10.1016/S0033-0620(97)80034-5 Get rights and content

Percutaneous transluminal coronary angioplasty (PTCA) has become a mainstay in the treatment of ischemic heart disease, with an estimated 300,000 procedures performed annually in the United States. Despite significant advances in reducing the acute complications of percutaneous revascularization procedures with periprocedural medications and better techniques, chronic restenosis of dilated lesions remains a serious and frequent problem, occurring in 30% to 50% of cases. With a peak incidence between 1 and 4 months after PTCA, restenosis has been thought to reflect an exaggerated healing response to balloon injury, in which platelets and other cells secrete mitogens that induce smooth muscle cells from the media to migrate to and proliferate in the intima, compromising the coronary lumen and invoking ischemic symptoms. Several factors, including remodeling with compensatory arterial enlargement, normalization of wall shear stress, and recoil, are also likely to play key roles. Based on these concepts, several pharmacological approaches directed at reducing the incidence of restenosis have been investigated. Although studies frequently report suppression of neointimal proliferation in animal models of balloon vascular injury, few drug approaches have met with clear success in clinical trials. This can be explained in several ways, including mistaken understandings of the pathophysiology of restenosis, gross histopathological dissimilarities between animal vascular injury models and clinical restenosis, and inadequate dosing. This report proposes to extensively review the vast literature on the subject to serve as a guide for clinicians to the pathophysiology of restenosis and the pharmacotherapeutic management of patients after PTCA and coronary atherectomy. Those drug approaches that currently show the most clinical promise and that warrant further investigation will be highlighted.

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Special ArticlePathophysiology and pharmacological approaches for prevention of coronary artery restenosis following coronary artery balloon angioplasty and related procedures

J Am Coll Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Am Heart J

Biochem Pharmacol

J Am Coll Cardiol

Thromb Res

Am J Cardiol

Am Heart J

Am J Cardiol

Am Heart J

Am J Cardiol

Nonoperative dilatation of coronary artery stenosis-percutaneous transluminal coronary angioplasty

N Engl J Med

In hospital morbidity and mortality in patients undergoing elective coronary angioplasty

Circulation

Percutaneous transluminal coronary angioplasty in 1985–1986, 1977–1981. The National Heart, Lung and Blood Institute Registry

N Engl J Med

Abrupt closure: The CAVEAT 1 Experience

J Am Coll Cardiol

Restenosis after successful coronary angioplasty in patients with single vessel disease

Circulation

Restenosis after percutaneous transluminal coronary angioplasty (PTCA): A report from the PTCA Registry of the National Heart, Lung and Blood Institute

Am J Cardiol

Incidence of restenosis after successful coronary angioplasty: A time related phenomenon

Circulation

Restenosis after percutaneous transluminal coronary angioplasty: The Emory University Hospital experience

Am J Cardiol

Long-term follow up after percutaneous transluminal coronary angioplasty. The early Zurich experience

N Engl J Med

Follow up clinical results in patients undergoing percutaneous transluminal coronary angioplasty

Circulation

Outcome in patients with recurrent restenosis after percutaneous transluminal balloon angioplasty

Br Heart J

Is percutaneous coronary angioplasty less expensive than bypass surgery?

N Engl J Med

Bilaterial mammary artery surgery or percutaneous transluminal coronary angioplasty for multivessel coronary artery disease? An analysis of effects and costs

Eur Heart J

Difference in acute gain (AG) and late loss (LL) relationship among three different new angioplasty devices (NAD)

Circulation

A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. The CAVEAT Study Group

N Engl J Med

A multicenter, randomized trial of coronary angioplasty versus directional atherectomy for patients with saphenous vein bypass graft lesions

Circulation

A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group

N Engl J Med

A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators

N Engl J Med

Acute and late angiographic results of the Stent Restenosis Study (STRESS)

J Am Coll Cardiol

Acute and chronic outcomes after physiologic low stress angioplasty (PLOSA) of de novo cornary stenoses: Results of the Phase I trial

Circulation

Intravascular ultrasound and restenosis: A cost analysis

Circulation

Intracoronary irradiation markedly reduces restenosis after balloon angioplasty in a porcine model

Circulation

High dose rate intracoronary irradiation suppresses neointimal proliferation in the stented and ballooned model of porcine restenosis

Circulation

Intracoronary irradiation markedly reduces restenosis after balloon angioplasty in a porcine model: Six month follow up

Circulation

Special Article
Pathophysiology and pharmacological approaches for prevention of coronary artery restenosis following coronary artery balloon angioplasty and related procedures