Antioxidants and Prevention of Restenosis After Directional Coronary Atherectomy

To the Editor: The negative results obtained with carvedilol in the European Carvedilol Atherectomy Restenosis (EUROCARE) trial led Serruys et al1 to question the value of antioxidants for the prevention of restenosis after coronary angioplasty. An important flaw in study design, however, invalidates the conclusions reached by the authors.The antioxidant probucol has been shown to prevent restenosis in several clinical studies, including the MultiVitamins and Probucol (MVP) trial2 and the Probucol Angioplasty Restenosis Trial (PART). Indeed, the only study in which probucol did not prevent restenosis after coronary balloon angioplasty allowed for only 24 hours of pretreatment. There is a massive release of reactive oxygen species very early after balloon injury,3 and adequate accumulation of a powerful antioxidant needs to have occurred at the time of angioplasty to control this oxidative stress. This was the basis for the pretreatment phase with probucol and for the bolus before angioplasty in MVP. In contrast, …