ABSTRACT
Restenosis has been the main drawback of coronary angioplasty since its inception nearly 25 years ago. The only widely accepted means of reducing restenosis has been the coronary stent, following the demonstration of reduced restenosis rates compared with percutaneous transluminal coronary angioplasty (PTCA) alone for comparable lesions.1,2 Currently, coronary stents are used in more than 77% of cases.3 Coincident with this increased stent use has been the more widespread treatment of more complex lesions that has led to the development of increased in-stent restenosis rates. In the USA alone, instent restenosis occurred in 10-50% of cases currently treated in everyday practice, accounting for 150 000 patients in 1999.4 Most pharmacological treatments failed to demonstrate improvement of restenosis rates after conventional balloon angioplasty or ablative techniques. In the current stent era, systemic pharmacological treatment has been tested, with controversial results. The aims of this chapter are to review the main trials designed to prevent restenosis with pharmacological treatment systemically administered during or after conventional balloon angioplasty and stent implantation, and to give pathophysiological insights into the effect of different drugs tested for the prevention of restenosis.
