IN-STENT RESTENOSIS - THE WASHINGTON-HOSPITAL-CENTER EXPERIENCE

In-stent restenosis has become a significant clinical problem, In 1997 alone, it is estimated that vp to 100,000 patients world-wide with in -stent restenosis were treated. Serial intravascular ultrasound (IVUS) analysis has shown that tubular-slotted stents almost never chronical ly recoil and that neointimal hyperplasia is responsible for in-stent restenosis. With the rapid recent explosion in stent use, information about in-stent restenosis has lagged behind, especially on the impact of new stent designs, For example, the true prevalence of in-stent res tenosis (1) varies with the lesion and patient subset, being much high er in the ''real world'' than in the selected patients typically enrol led in many studies; and (2) depends on its definition (i.e., clinical vs angiographic, intralesion vs in-stent). ''Conventional'' catheter- based treatments have included percutaneous transluminal coronary angi oplasty (PTCA), rotational atherectomy, excimer laser coronary angiopl asty, directional coronary atherectomy, and additional stent implantat ion. Rates of recurrence with these approaches are not known and vary considerably among series; however, certain lesions seem likely to rec ur regardless of the treatment modality. Recently, brachytherapy has e merged as the most promising way to treat in-stent restenosis. (C) 199 8 by Excerpta Medica, Inc.