What is the preferable treatment for stent restenosis?

This study compared the outcomes of two new percutaneous coronary intervention (PCI) treatments for recurring coronary artery disease, a paclitaxel-eluting stent and a paclitaxel-eluting balloon.

Coronary artery disease (CAD) is the gradual (sometimes sudden) narrowing of the arteries that supply heart muscle with blood (coronary arteries). PCI is a non-surgical method used to treat CAD. Types of PCI include 'balloon angioplasty' (widening of the narrowed artery without leaving a stent inside) and 'stenting' (placement of a thin flexible tube).

During the procedure a catheter is inserted into the blocked artery with a balloon at its end. The balloon inflates to widen around the blockage. Thereafter a stent can be placed on site to maintain the artery open. A major drawback of stents is their tendency to become blocked again, known as 'restenosis'.

A Drug-eluting stent (DES) is a type of stent that releases a drug that prevents cells from clogging it, but the likelihood of restenosis is still high. Paclitaxel is a drug which limits scar tissue growth, which can lead to restenosis, and it is now used in paclitaxel-eluting stents (PES) and a paclitaxel-eluting balloons (PEB).  The current study examines whether one of these treatments is more effective at decreasing the rates of restenosis.

This study included 402 patients who were diagnosed with restenosis following a previous PCI procedure.  Patients were randomly assigned to one of three treatment groups:  34% PEB; 33% PES; and 33% received a non-drug-eluting balloon angioplasty. Patients were assessed at 1 month and 12 months following their procedures, and underwent angiography (a diagnostic test to detect regions of coronary artery narrowing) 6 to 8 months post-procedure. 

The authors measured the level of blockage at the follow-up angiography to determine whether there was a difference in outcome between the procedures. They found no difference in blockage levels between the PEB (38%) and PES (37.4%) groups, compared to the balloon angioplasty group, who had a restenosis rate of 54.1%.

In summary, for CAD patients who experience restenosis, it makes no difference if paclitaxel-eluting stent or balloon are used for secondary prevention. However, balloon angioplasty alone is not a sufficient treatment.

The present study was based on a very homogenous group of patients: all participants were previously treated with one specific type of DES. This means, that results may not be relevant to patients treated otherwise.

Restenosis is preferably treated with repeated stenting, rather than be balloon angioplasty alone, which is more likely to cause another restenosis. Thus, the comparison between a stent and a balloon is non-practical. 

If you have restenosis, discuss with your doctor the various treatment options.