Author Affiliations: The Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington.
Published online March 12, 2006 (doi:10.1001/jama.295.11.1307).
The greatest recent mechanical advance in percutaneous coronary revascularization (PCR) has been the development of bare-metal stents, which compared with traditional balloon angioplasty substantially reduce angiographic restenosis and the need for repeat target vessel revascularization (TVR). Stents provide a larger arterial lumen diameter immediately postprocedure (acute gain), although their drawback is an increased reparative response of neointimal formation (late loss). Fortunately, the net gain remains greatest with stents compared with other PCR devices. In less complex lesions, the rate of TVR with bare-metal stents is approximately 10% to 15%, although this rate has been reported to be 2- to 3-fold higher in more complex lesions and unique patient subsets.1,2 In 2003, at a time when the use of bare-metal stents peaked, approximately 1 million coronary stents were placed in patients hospitalized in the United States.3 Even with a conservative estimate, this means at least 100 000 in-stent restenotic lesions occurred, making this an important clinical problem.
Mukherjee D, Moliterno DJ. Brachytherapy for In-Stent RestenosisA Distant Second Choice to Drug-Eluting Stent Placement. JAMA. 2006;295(11):1307-1309. doi:10.1001/jama.295.11.1307