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  • Review Article
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Restenosis after PCI. Part 2: prevention and therapy

Nature Reviews Cardiology volume 9, pages 79–90 (2012)Cite this article

Subjects

Abstract

The techniques and materials used during percutaneous coronary intervention have advanced considerably over the past 3 decades, yet restenosis remains one of the major drawbacks of this procedure. Many innovative technologies, including drug-eluting stents, with or without specific polymers, and fully biodegradable stents have been and continue to be developed in the search for a safe and effective antirestenosis therapy. Remarkable advances in stent design and nanoparticle delivery systems ('nanovehicles') have already fueled revolutionary changes in the prevention and treatment of in-stent restenosis. In this Review we provide an overview of the latest innovations for optimizing outcomes of coronary stenting, and up-to-date information about prevention and treatment of in-stent restenosis.

Key Points

  • Although drug-eluting stents decrease the incidence of restenosis, they do not yet fully prevent this problem; furthermore, long-term safety issues indicate that new technologies are still warranted

  • New-generation polymer coatings, including biocompatible permanent polymers and biodegradable polymers, and stents without a polymer, represent innovative technologies that aim to preserve vascular biology in the long term

  • Biodegradable stents prevent the long-term problems associated with foreign material in the coronary arteries; the first human studies employing these stents show promising results

  • Nanoparticle-mediated drug delivery systems are expected to revolutionize the development of innovative therapeutic devices, allowing local or targeted delivery of the drug with an excellent biocompatibility profile

  • Drug-eluting balloons provide homogenous drug distribution in the vascular wall and represent a favorable option for the treatment of restenosis

  • Gene-eluting stents are expected to play an important role in the prevention of in-stent restenosis, particularly in patients with a high genetic-risk profile

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Figure 1: Chemical structure of biolimus A9.
Figure 2: The bioabsorbable stent.
Figure 3: Patterns of in-stent restenosis.

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Acknowledgements

J. W. Jukema has received funding from the European Union's Seventh Framework Program (FP7/2007-2013) under grant agreement n° HEALTH-F2-2009-223,004 and he is supported by grants from the Interuniversity Cardiology Institute of the Netherlands (ICIN) and the Durrer Center for Cardiogenetic Research both Institutes of the Netherlands Royal Academy of Arts and Sciences (KNAW), the Netherlands Heart Foundation, the Center for Medical Systems Biology (CMSB), a center of excellence approved by the Netherlands Genomics Initiative/Netherlands Organization for Scientific Research (NWO), the Netherlands Consortium for Healthy Ageing (NCHA). T. A. N. Ahmed would like to thank the Egyptian Ministry of Higher Education and Asyut University for financially supporting him during his research and clinical fellowship in the Netherlands. P. H. A. Quax is an established investigator of the Netherlands Heart Foundation (M93-001). The funders had no role in the preparation of, or decision to publish, the manuscript.

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  1. Department of Cardiology, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands

    J. Wouter Jukema, Tarek A. N. Ahmed & Jeffrey J. W. Verschuren

  2. Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands

    Paul H. A. Quax

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J. W. Jukema, T. A. N. Ahmed and J. J. W. Verschuren researched data for and wrote the article. All authors contributed to the discussion of content. J. W. Jukema, J. J. W. Verschuren and P. H. A. Quax reviewed/edited the article before submission. J. W. Jukema and T. A. N. Ahmed contributed equally to this paper.

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Jukema, J., Ahmed, T., Verschuren, J. et al. Restenosis after PCI. Part 2: prevention and therapy. Nat Rev Cardiol 9, 79–90 (2012). https://doi.org/10.1038/nrcardio.2011.148

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