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Restenosis After Angioplasty and Stenting

Managing restenosis

By , About.com Guide

Updated August 20, 2004

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How is restenosis treated?

Once restenosis has occurred, treatment depends on the clinical situation.

If the original invasive procedure was angioplasty without stenting, the next step once restenosis occurs is usually to repeat the angioplasty, and this time insert a stent.

If restenosis occurs within stent, it is usually treated by repeating an angioplasty. However, once restenosis has occurred, the chance of a second restenosis nearly doubles.

Managing in-stent restenosis has been a major challenge. It is usually treated with repeated angioplasty, insertion of a second stent (sometimes a drug-coated stent, although these are not supposed to be used within a stent,) and occasionally by brachytherapy (intracoronary radiation). Click here for a recent comprehensive review of brachytherapy.

Of course, other alternatives could be considered at any time. These might include – depending on circumstances – anti-anginal drug therapy, coronary artery bypass surgery, or EECP.

Summary

Restenosis remains the major Achilles heel of intra-coronary stent therapy. However, the risk can be greatly reduced by the appropriate use of antithrombotic drugs, and where appropriate, drug-coated stents. If it occurs it can most often be managed by repeating angioplasty, or by using intra-coronary radiation (brachytherapy.) Stent technology is developing rapidly, however, and restenosis will probably become much less a problem in the future.

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