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Updated: Aug 25, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Drug-eluting stents for in-stent restenosis and acute myocardial infarction: present data from nonrandomized studies
Joachim Schofer1, Christoph Bode, Sigmund Silber
1Center for Cardiology and Vascular Intervention, Hamburg, Germany. schofer@center-for-cardiology.de
Insights
Drug-eluting stents (DES) show promise for in-stent restenosis (ISR), though brachytherapy is standard. Ongoing trials and registry data are evaluating DES efficacy and safety for ISR, particularly in acute myocardial infarction (AMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- In-stent restenosis (ISR) is a significant complication of percutaneous coronary intervention.
- Drug-eluting stents (DES) have transformed de novo coronary lesion treatment but their role in ISR is less defined.
- Intracoronary brachytherapy is the current standard of care for ISR.
Purpose of the Study:
- To review current evidence on the use of DES for ISR.
- To present the design of ongoing randomized trials comparing DES with brachytherapy for ISR.
- To assess the safety and efficacy of DES in patients with acute myocardial infarction (AMI).
Main Methods:
- Review of observational studies and registries on DES for ISR.
- Description of ongoing randomized trials (sirolimus-eluting and paclitaxel-eluting stents vs. brachytherapy).
- Analysis of data from patients with AMI treated with DES.
Main Results:
- Limited but emerging data suggest DES may be effective for ISR.
- Ongoing trials will provide robust evidence comparing DES and brachytherapy.
- Small studies indicate sirolimus-eluting stents are safe and effective in AMI patients.
Conclusions:
- DES are increasingly used for ISR despite limited definitive data.
- Randomized trials are crucial for establishing DES as a viable ISR treatment.
- Current evidence supports the use of sirolimus-eluting stents in AMI patients.
Abstract:
In-stent restenosis (ISR) remains the "Achilles' heel" of percutaneous stent angioplasty treatment of patients with atherosclerotic disease of the coronary arteries. Recently, drug-eluting stents (DES) have ushered in a revolution in the treatment of these patients, yet, to date, their efficacy and safety have been demonstrated primarily for native de novo coronary lesions. For ISR, intracoronary brachytherapy using beta- or gamma-radiation is considered the standard of care. Nevertheless, DES are used for ISR lesions in clinical practice. This review outlines the few results currently available from small observational studies and larger registries. The designs of two ongoing randomized trials evaluating the sirolimus-eluting and the paclitaxel-eluting stent versus brachytherapy in patients with ISR lesions are also presented. Patients with acute myocardial infarction (AMI) have mostly been investigated in the context of small, uncontrolled studies and registries. The incomplete evidence to date is that implantation of sirolimus-eluting stents in patients with AMI is safe and effective.
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