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Restenosis
An ongoing problem with angioplasty, however, is that about one-third of the time, the arterial blockage returns, usually within six months. It is thought that the mechanism of this phenomenon, called "restenosis", is not the progression of coronary artery disease, but rather the body's immune system response to the "injury" of the angioplasty. At this point a repeat procedure may need to be performed.
  cross section of restenosed artery
cross section of restenosed
artery (dark red)

radiation catheter
radiation catheter
(courtesy Cordis)
 

The use of stents has lowered this rate of recurrence or restenosis, and new types of devices that release clot-deterring medicine or even certain forms of radiation have been developed in the hopes of reducing this problem even further. Several investigational clinical studies have been in progress to determine the effective dose levels and optimum delivery systems of gamma or beta radiation (brachytherapy) but the most recent results (five year data) are not encouraging. Both Cordis and Guidant have ceased marketing their brachytherapy devices and many hospitals no longer use them.

 


The newest development in the ongoing battle to reduce restenosis is the drug-eluting stent -- a stent which has a medication (an immunosupressant or antibiotic) coated on it to reduce the proliferation of cells that can cause re-clogging. Currently the CYPHER™ stent from Cordis/Johnson & Johnson and the TAXUS™ from Boston Scientific have been approved for use in the U.S.. Both these stents have shown greatly reduced restenosis rates (single digits) for even diabetic patients. Read more about these devices in our special feature: "Drug-Eluting Stents"  
cross section of restenosed artery
Drug-Eluting Stent
(courtesy Boston Scientific)

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