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Updated: Jun 23, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Using the risk of restenosis as a guide to triaging patients between surgical and percutaneous coronary
Richard Kettelkamp1, John House, Mukesh Garg
1Mid America Heart Institute, 5th Floor, Saint Luke's Hospital and the University of Missouri-Kansas City, 4100 Wornall Road, Kansas City, MO 64111, USA. kettelkampd@umkc.edu
Insights
Patients at high risk for restenosis are increasingly treated with percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG). This trend suggests a need to re-evaluate current patient triage strategies for coronary revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI) are key revascularization strategies.
- Restenosis is a primary limitation of PCI, suggesting CABG may be preferred for high-risk patients.
- This study investigates referral patterns based on predicted restenosis risk.
Purpose of the Study:
- To analyze referral patterns between PCI and CABG in relation to predicted restenosis risk.
- To determine if patients with higher restenosis risk are preferentially referred for CABG or PCI.
Main Methods:
- Analysis of a procedural registry of 2320 revascularization patients.
- Patients were categorized into three risk groups for restenosis (11%–44%) based on eight preprocedural characteristics.
- Referral patterns for PCI versus CABG were examined across these risk categories.
Main Results:
- Of 2060 non-emergent revascularization procedures, 1404 were PCI and 656 were CABG.
- Patients with low and intermediate restenosis risk were twice as likely to receive PCI.
- Patients at the highest risk for restenosis were three times more likely to receive PCI (P=0.015), indicating a preferential trend towards PCI.
Conclusions:
- Current clinical practice shows a preferential referral of high-restenosis-risk patients to PCI, contrary to expectations.
- These findings necessitate a re-evaluation of patient triaging between PCI and CABG.
- The results may inform the optimal use of drug-eluting stents in PCI patients.
Background:
Coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI) are strategies for treating coronary disease. Because the principal limitation of PCI is restenosis, CABG might be favored for those at high risk for restenosis. Using a clinical risk score for predicting restenosis, we examined whether patients with higher risks for restenosis were preferentially referred for CABG.
Methods And Results:
A procedural registry of 2320 revascularization patients from whom data on procedure type, demographics, comorbid conditions, health status, vessel anatomy, and outcomes were taken was analyzed. Patients were classified and scored into 3 categories of restenosis risk ranging from 11% to 44%, as defined by 8 preprocedural characteristics. The objective of this study was to describe referral patterns between PCI and CABG in each category of risk. 2060 patients underwent nonemergent revascularization. 1404 of the patients underwent PCI and 656 were treated with CABG. Among the patients at low and intermediate risk for restenosis, twice as many were referred to PCI. Among those at the highest risk, 3-times as many were referred to PCI, resulting in a significant trend for those with the higher risks of restenosis to be preferentially referred to PCI (P=0.015). Similar results were seen when the analysis was restricted to only those with multivessel disease.
Conclusions:
Patients at higher risk for restenosis were being preferentially treated with PCI as opposed to CABG. These results may have implications for reevaluating current patterns of triaging patients between PCI and CABG, and for the use of drug-eluting stents within PCI patients.
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