The stenotic stent: Mechanisms and revascularization options

Abstract

As demonstrated by the two recent randomized studies of elective, single stent placement versus balloon angioplasty of de novo lesions in the coronary arteries, angiographic restenosis occurs significantly less after stent implantation. However, reported stent restenosis rate varies from 14% to more than 60%, depending on patient characteristics, stent design, number of stents implanted, vessel treated, location of the lesion, and acute luminal gain. The lowest rate of stenosis occurs in de novo lesions. The highest rate of stent restenosis is encountered in multiple stents and in ostial saphenous vein graft lesions. Stent restenosis can be treated with balloon angioplasty with very high success rates. This treatment is associated with remarkably low incidence of complications. Focal stenoses within the stent are more easily treated than are diffuse occlusions. Atherectomy of intrastent stenosis is not recommended. Excimer and holmium: YAG lasers can be applied for revascularization of intrastent lesions considered "not ideal" for balloon angioplasty. Unless thrombus is present or significant dissection detected or angioplasty performed within 2 months following stenting, patients do not require anticoagulants following balloon angioplasty of stent restenosis.