CORONARY STENT IMPLANTATION IN PATIENTS AFTER MULTIPLE PTCA RESTENOSIS

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Metallic intracoronary stents have been proposed as a treatment alternative for patients with episodes of recurrent restenosis after standard balloon angioplasty (PTCA). Assuming a component of restenosis pathophysiology is elastic recoil of the vessel segment, a permanent implantable scaffold should retain expanded lumen dimensions and prevent hemodynamically significant narrowing of the vessel. To test the hypothesis that intracoronary stent implantation prevents restenosis in patients after standard PTCA, we studied the acute and long-term responses in a group of patients (n-21) who have had at least 2 episodes of previous restenosis. Intracoronary stents were placed to cover sites of previous restenosis after standard primary angioplasty. Although some degree of neointamal proliferation was present in most follow-up angiograms (at 4-6 months after stent implantation), clinical restenosis was not observed and angiographic restenosis was noted only in 1 of 10 patients during the follow-up period. Although this represents a preliminary report, we are encouraged that stent implantation in the setting of recurrent restenosis after standard PTCA maybe a beneficial treatment modality to improve long-term vessel patency and maintain clinical stability.