[Treatment of stent restenosis using rotational atherectomy: mechanisms and results]

Restenosis after coronary stent implantation remains one of the major limitations of this treatment modality. At present, redilatation is considered the therapeutic option of choice for focal lesions; however, long restenotic lesions (> 10 mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation). Rotablation has been studied most extensively with acute and long-term results published in a total of 500 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first two randomised clinical trials (ROSTER and A.R.T.I.S.T. trials) have now been published in abstract form, with conflicting results: whereas the monocenter ROSTER trial suggests a clinical benefit to patients treated by the rotablator, the multicenter A.R.T.I.S.T. trial including nearly 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis. Currently, rotablation for the treatment of restenosis can not be considered as the first line treatment modality in patients with stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity will become mandatory.