Restenosis related to percutaneous coronary intervention has been solved?

Figures & data

Table I. Summary of major clinical trials on the efficacy of drug‐eluting stents. Target lesion revascularization (TLR) rate is used as the adverse clinical endpoint.

Study acronym	Comparison	Patients (n)	Follow‐up (months)	Target lesion revascularization (%)			Ref
				SES	PES	BMS
RAVEL	SES vs BMS	114/113	36	6.3	25.0		57
SIRIUS	SES vs BMS	533/525	12	4.9	20.0		59
TAXUS I	PES vs BMS	31/30	12	3.0	10.0		60
TAXUS IV	PES vs BMS	662/652	9	4.4	15.1		5
ENDEAVOR	AES vs BMS	598/599	12	6.0	12.1		64
JUPITER II	TES vs BMS	157/160	9	5.7	10.0		65
Diabetic patients:
DIABETES	SES vs BMS	80/80	9	11.3	31.3		77
TAXUS IV	PES vs BMS	155/163	12	7.4	20.9		20
Small coronaries:
SES‐SMART	SES vs BMS	129/128	8	7.0	21.1		78
E‐SIRIUS	SES vs BMS	175/177	8	4.0	20.9		80
C‐SIRIUS	SES vs BMS	50/50	9	4.0	18.0		81
TAXUS V	PES vs BMS	108/95	9	10.4	21.5		79
Long lesions:
E‐SIRIUS	SES vs BMS	175/177	8	4.0	20.9		80
C‐SIRIUS	SES vs BMS	50/50	9	4.0	18.0		81
TAXUS V	PES vs BMS	193/183	9	12.6	28.2		79
TAXUS VI	PES vs BMS	219/227	9	6.8	18.9		62
Paclitaxel vs sirolimus trials:
ISAR‐DIABETES	SES vs PES	125/125	9	6.4	12.0		26
TAXi	SES vs PES	102/100	7	3.0	1.0		71
SIRTAX	SES vs PES	503/509	9	4.8	8.3		72
REALITY	SES vs PES	684/669	8	5.0	5.4		73
ISAR‐DESIRE	SES vs PES vs BMS	100/100/100	12	8.0	19.0	33.0	82
In‐stent restenosis trials
ISAR‐DESIRE	SES vs PES vs BMS	100/100/100		8.0	19.0	33.0	82
				SES	VBT
SISR	SES vs VBT	259/125	9	8.5	19.2		83

Notes: AES = ABT‐578 eluting stent; BMS = bare metal stent; PES = paclitaxel‐eluting stent; Ref = reference number; SES = sirolimus‐eluting stent; TES = tacrolimus‐eluting stent; VBT = vascular brachytherapy.

Figure 1. Restenosis of a coronary artery after balloon angioplasty(a–b) and after stenting (c–d).

Figure 2. Development of neointimal hyperplasia.(a): Macrophages and cholesterol in the atherosclerotic plaque. (b): Rupture of the vessel wall results in activation of the thrombosis cascade, inflammation. Foreign body reaction caused by the stent results in inflammation and local accumulation of growth factors. (c): The smooth muscle cells (SMC) activate, migrate inside the stent and proliferate. (d): The process fades as soon as the endothelium covers the neointima. Modified from Welt and Rogers 12.

Figure 3. Need of target lesion revascularization(TLR) after percutaneous coronary intervention (PCI) with drug‐eluting stents (white bars) and bare metal stents (grey bars). Numbers refer to number of patients in each group. Modified from references 59, 5, 64 and 65.

Figure 4. Need of reintervention after percutaneous coronary intervention with respect to the length of the stent and diameter of the stent. Drug‐eluting stent (left panel) and bare metal stent (right panel). Modified from Stone, TCT 2004 61.

Table

ARTS	Arterial Revascularization Therapies Study
ARTS II	Arterial Revascularization Therapies Study II
BARI	Bypass Angioplasty Revascularization Investigation
BENESTENT	Belgium‐Netherlands STENT
CABRI	Coronary Angioplasty versus Bypass Revascularization Investigation
CARDIA	Coronary Artery Revascularization in Diabetes
CART‐1	Canadian Antioxidant Restenosis Trial
C‐SIRIUS	Canadian Sirolimus‐Eluting Stent Versus a Standard Stent
CREST	Cilostazol for RESTenosis
DIABETES	Randomized comparison of sirolimus‐eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients: the diabetes and sirolimus‐eluting stent (DIABETES) trial
EAST	Emory Angioplasty versus Surgery Trial
ENDEAVOR	ABT‐578 stent trial series (Name of the stent)
E‐SIRIUS	European Sirolimus‐Eluting Stent Versus a Standard Stent
FIM	First In Man
FREEDOM	Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease
FUTURE	First Use To Underscore Restenosis reduction with Everolimus
GABI	German Angioplasty Bypass Surgery Investigation
ISAR‐DESIRE	Intracoronary Stenting and Angiographic Results: Drug‐Eluting Stents for In‐stent REstenosis
ISAR‐DIABETES	The Intracoronary Stenting and Angiographic Results: Do Diabetic Patients Derive Similar Benefit from Paclitaxel‐Eluting and Sirolimus‐Eluting Stents
ISAR‐SMART	Intracoronary Stenting or Angioplasty for Restenosis reduction in Small ARTeries
ISAR‐TEST	Intracoronary Stenting and Angiographic Restenosis—Test Equivalence between two drug‐eluting Stents Trial
JUPITER	Janus‐stent trial
KAT	Kuopio Angioplasty Trial
MVP	MultiVitamins and Probucol
ORBIT	Oral Rapamune to inhiBIT restenosis
OSIRIS	Oral Sirolimus to Inhibit Recurrent In‐stent Stenosis
RAVEL	RAndomized study with the sirolimus‐eluting Bx VELocity balloon‐expandable stent
REALITY	Taxus versus Cypher trial
RESEARCH	Rapamycin‐Eluting Stent Evaluated At Rotterdam Cardiology Hospital
RITA	Randomized Intervention Treatment of Angina
SES‐SMART	Sirolimus‐Eluting Stent in the Prevention of Restenosis in Small Coronary Arteries
SIRIUS	Sirolimus‐Eluting Stent Versus a Standard Stent
SIRTAX	SIRolimus‐Eluting and PacliTAXel‐Eluting Stents for Coronary Revascularization
SISR	Sirolimus in In‐Stent Restenosis
SoS	Stent or Surgery
SPIRIT‐FIRST	Everolimus‐stent trial
STARS	STent Anticoagulation Restenosis Study
STRESS	STent REStenosis Study
SYNTAX	Taxus versus Cypher trial
TAXi	Trial comparing TAXus and Cypher stents
TAXUS	Paclitaxel stent trial series (Name of the stent)

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