Modification of molecular events in coronary restenosis using coated stents: The Mayo Clinic Approach

Restenosis remains the major problem in interventional cardiology today. The intracoronary stent is an indispensable part of the interventional coronary practice. Restenosis rates, using current third generation devices in straightforward lesions are now less than 10%. Advances in stenting have had a remarkable effect on the safety and efficacy of clinical practice. Now that stents are easily deployed, and have shown substantive clinical impact, questions arise about the future of stenting. Answers to this question centre on several remaining problems with current stent technology and interaction with the biology of coronary arteries. One method to accomplish this is to have the material of the stent interact directly with the vessel. This can be achieved by better stent materials, or by impregnating the stent with drugs or genes to modify the vessel wall. This chapter will describe several such approaches under consideration.