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Ketanserin prevents early restenosis following percutaneous transluminal coronary angioplasty
Abstract:
In the treatment of coronary artery stenoses restenosis represents the main problem in 25-35% of cases following successful percutaneous transluminal coronary angioplasty (PTCA). In the present trial the effect of the 5HT2-serotonergic receptor antagonist ketanserin on the rate of restenosis after 24 h ('early restenosis') or 4-9 months ('late restenosis') was investigated. Preliminary studies demonstrated that ketanserin infused at the dose of 0.1 mg/min inhibited platelet aggregation without evidence of side effects. In the restenosis study, 43 patients (37 males, 6 females; mean 55 years) were randomized into two groups. After PTCA, 22 patients were treated with conventional therapy (group A), whereas 21 received additionally ketanserin (0.1 mg/min for 24 h, group B). The angiograms (prior to, after, 24 h after, and 4-9 months after PTCA) were examined in a blind manner using a computer-based quantitative angiographic system. After 24 h, 3 patients of group A, but none of group B showed restenosis (more than 50% decrease in diameter stenosis). In total, the diameter at the site of stenosis prior to PTCA decreased by 11% in the controls, but remained unchanged in the ketanserin-treated patients. After 4-9 months, 26% of group A (5 out of 19 patients examined) and 22% of the controls (4 out of 18 patients examined) developed restenosis of more than 50%; there was no statistical difference in the degree of residual stenosis between both groups. These findings suggest that a 24-hour infusion of ketanserin following PTCA may prevent early restenosis, but does not influence the incidence of late restenosis.
Insights
Ketanserin prevents early restenosis after percutaneous transluminal coronary angioplasty (PTCA) by inhibiting platelet aggregation. However, this 5HT2-serotonergic receptor antagonist does not impact late restenosis rates in coronary artery disease patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Restenosis is a significant complication after percutaneous transluminal coronary angioplasty (PTCA), occurring in 25-35% of cases.
- The 5HT2-serotonergic receptor antagonist ketanserin has shown potential in inhibiting platelet aggregation without adverse effects.
Purpose of the Study:
- To investigate the effect of ketanserin on early (24-hour) and late (4-9 month) restenosis rates following PTCA.
- To evaluate ketanserin's impact on coronary artery diameter changes post-PTCA.
Main Methods:
- A randomized trial involving 43 patients undergoing PTCA.
- Group A (n=22) received conventional therapy; Group B (n=21) received conventional therapy plus a 24-hour infusion of ketanserin (0.1 mg/min).
- Quantitative angiographic analysis was performed before, after, 24 hours after, and 4-9 months after PTCA.
Main Results:
- No patients in the ketanserin group (Group B) experienced early restenosis at 24 hours, compared to 3 patients in the control group (Group A).
- Coronary artery diameter stenosis remained unchanged in the ketanserin group, while it decreased by 11% in the control group at 24 hours.
- Late restenosis rates at 4-9 months were similar between groups (26% in Group A vs. 22% in Group B), with no significant difference in residual stenosis.
Conclusions:
- A 24-hour infusion of ketanserin following PTCA may effectively prevent early restenosis.
- Ketanserin does not appear to influence the incidence of late restenosis after PTCA.
- Further research is warranted to explore the long-term efficacy and optimal use of ketanserin in managing coronary artery disease.