Abstract
In-stent restenosis remains the limitation of coronary stent implantation despite numerous efforts of its prevention by catheter-based techniques or by drug therapy. Today, only intravascular irradiation has proven to effectively reduce neointima formation, restenosis rate and major adverse cardiovascular events by approximately 50%. Its efficiency is demonstrated for high-risk subsets like long lesions, lesions in saphenous venous bypass grafts or diabetic patients, indicating the extraordinary potential of vascular irradiation. Yet vascular irradiation has some limitations. Edge effect describes the phenomenon of excessive neointimal proliferation at the edges of an irradiated segment and is likely due to axial dose fall-off and / or barotrauma by the angioplasty procedure. Geographic miss, the combination of dose fall-off and vessel injury may be deleterious, especially if a new stent is implanted. The use of appropriate radiation source lengths to avoid geographic miss substantially reduces the incidence of edge effect. Late thrombosis, occurring even years after irradiation, had significantly diminished the benefit of vascular irradiation in initial clinical trials, but extension of ntiplatelet therapy up to 12 months after irradiation has reduced its rates to placebo levels. Vascular brachytherapy is of considerable clinical benefit in the prevention of restenosis and the only proven option for the treatment of in-stent restenotic lesions. This review will focus on the mechanisms of action of vascular irradiation, on the pathophysiological reasons for its complications and therapeutic options. Both angiographic and clinical results of randomised and observational studies will be updated in detail.
Keywords: in-stent restenosis, coronary angioplasty, intravascular irradiation, coronary stents, late thrombosis, edge effect
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
Related Journals
Anti-Cancer Agents in Medicinal Chemistry
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry
Current Bioactive Compounds
Current Cancer Drug Targets
Combinatorial Chemistry & High Throughput Screening
Current Cancer Therapy Reviews
Current Diabetes Reviews
Current Drug Safety
Current Drug Targets
Current Drug Therapy
Related Books
Drug Addiction Mechanisms in the Brain
The NLRP3 Inflammasome: An Attentive Arbiter of Inflammatory Response
Software and Programming Tools in Pharmaceutical Research
Objective Pharmaceutics: A Comprehensive Compilation of Questions and Answers for Pharmaceutics Exam Prep
Medicinal Chemistry of Drugs Affecting Cardiovascular and Endocrine Systems
Advanced Pharmacy
Plant-derived Hepatoprotective Drugs
The Role of Chromenes in Drug Discovery and Development
New Avenues in Drug Discovery and Bioactive Natural Products
Practice and Re-Emergence of Herbal Medicine
2
