[Predictive factors of restenosis: what changes with "active" stents?]

For many years, restenosis was the major limiting factor of coronary angioplasty, even since the systematic use of stents. Numerous scientific publications have aimed to define the predictive factors of this phenomenon. Factors such as diabetes, the size of the treated artery, the use of stents or not, the length of the lesion, lesion located on the proximal left anterior descending artery, the degree of residual stenosis post-angioplasty (assessed by angiography or by intravascular ultrasound) have all been evoked as being classically related to restenosis. However, our perception of the restenosis phenomenon has been dramatically changed by the demonstration of the efficacy and security of active stents. Even in so-called "at risk" populations, the use of active stents is rarely followed by restenosis. In this way, the classic risk factors for restenosis have now become arguments in favour of the implantation of an active stent. As long as budgetary constraints limit the use of active stents to patients said to be "at risk of restenosis", this population, quite paradoxically, will have a more favourable outcome than so-called "low risk" patients, in whom "ordinary" non-active stents will continue to be used.