Drug-Eluting Stent Restenosis

In 1977, using a wire-tipped balloon, Dr Andreas Gruentzig performed the first percutaneous coronary intervention on a blockage in Mr Adolph Bachmann’s left anterior descending coronary artery.1a The continued success of this pioneering event has been documented by follow-up angiography at 10 years and again at 23 years postprocedure. Mr Bachmann’s follow-up angiograms may be the most viewed on the planet, because they were obtained during dramatic, live demonstration conferences in front of thousands of physicians and were published in the New England Journal of Medicine .1b In fact, Mr Bachmann was recently honored at an event attended by over 10 000 people at a large medical meeting. It is indeed very fortunate for the field of interventional cardiology that Mr Bachmann’s left anterior descending artery blockage did not recur.Article see p 42 In 2010, despite all the promising technology and all the research, creativity, effort, and dollars poured into the field, the problem of restenosis, although vastly reduced, has not been eliminated. It is not an exaggeration to state that at my institution, Scripps Clinic, nearly every working day we see at least 1 patient with restenosis of a drug-eluting stent (DES). One report estimated 200 000 repeat revascularizations are performed every year in the United States for DES failure.2 Despite tremendous progress in lowering the incidence of restenosis with DES, given the large number of percutaneous coronary intervention procedures performed worldwide every year, even a low restenosis rate translates into a significant absolute number of patients experiencing this problem. The problem of DES restenosis is pervasive enough that all physicians caring for patients with coronary disease should be well versed in its treatment.Early data from the bare-metal stent era informed us that if restenosis were to occur, we could expect it within 6 …