Prevention of Restenosis by Systemic Drug Therapy

Abstract

In this issue of Circulation , 2 studies report a positive outcome in patients who received oral pharmacotherapy for the prevention of restenosis after stent placement. In the randomized, double-blind, placebo-controlled Cilostazol for Restenosis Trial (CREST) trial,1 patients were given cilostazol, a phosphodiesterase 3 inhibitor with antithrombotic2 and antiproliferative3 properties, for 6 months starting immediately after implantation of a bare-metal stent in a de novo target lesion. Minimal lumen diameter, the primary end point of this study, which comprised 705 patients, was larger among patients treated with cilostazol than among those who received placebo. Other angiographic but not clinical outcomes were also more favorable among patients assigned to the active treatment arm. Articles pp 2792 and 2826 The second study investigated the effect of a 6-month treatment with the thiazolidinedione pioglitazone on neointima formation measured by intravascular ultrasound 6 months after bare-metal stent implantation for de novo coronary artery lesions.4 In this small study, which comprised a total of 50 nondiabetic patients, neointima formation was significantly reduced among patients treated with pioglitazone compared with those who received placebo. Similarly, angiographic and clinical measures of restenosis were better among patients assigned to pioglitazone treatment. Although potential beneficial effects of thiazolidinedione regarding the prevention of neointima formation include antiinflammatory5 and antiproliferative effects,6 the exact mechanism by which pioglitazone led to a reduction of neointima formation among patients included in this study remains elusive. The findings of these studies add to the existing evidence on the use of systemic pharmacological approaches to prevent restenosis. For most of these approaches, initial positive results in animal models of vascular injury and/or small pilot studies have been followed by disappointing results in large clinical trials. Basically, …