Why Does Restenosis Happen (and What Can Be Done About It)?
Restenosis, or when an artery gets blocked again after you’ve had it reopened, unfortunately happens. Understand why and what treatments are available.
Good blood flow throughout your body is obviously important. That’s why stenosis, or narrow blood vessels, is a problem. And unfortunately, this problem can happen again after you’ve had a blocked artery reopened. That’s when it becomes restenosis.
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Stent placement helps restore blood flow through previously blocked arteries, but some patients develop restenosis (re-narrowing) over time.
Stephen Ellis, MD, Director of Interventional Cardiology, explains, “There are effective ways to restore blood flow if restenosis occurs, but it’s important to assess the cause and to tailor treatment accordingly.”
Despite advances, Dr. Ellis says, “in-stent restenosis still occurs in approximately 3 to 10% of patients within six to nine months, and sometimes afterwards. We have learned that restenosis is a very complex process.”
Some known causes include:
• Stents that are too small or misaligned in the blood vessel.
• Older-generation stents.
• Abundant healing within the stent with scarring.
Before any treatment for restenosis, your doctor will perform tests to understand what’s causing any problems. Catheterization allows doctors to look inside the artery and to perform tests including:
Different options are available to treat restenosis the first time it happens:
For some patients, restenosis is a recurring problem. If the blockage has recurred several times or if there are multiple blockages, your doctor may recommend bypass surgery to restore adequate blood flow.
Other options include:
Medicines. Two oral medications may somewhat lessen the risk of restenosis: sirolimus, the drug used on the first generation of drug-eluting stents, and cilostazol, another type of medicine that helps widen blood vessels and reduce clumping of red blood cells. These are typically used in conjunction with balloon or cutting balloon angioplasty.
Though sometimes useful, these drugs aren’t for every patient and they require more study, Dr. Ellis says.
Brachytherapy. This treatment uses radiation to keep scar tissue from building up again in the stent. Doctors perform brachytherapy at the same time as angioplasty.
After completing angioplasty, the doctor threads another catheter with a “ribbon” of radioactive particles (isotopes) to the blockage, leaves it in place for a few minutes, and then removes the catheter.
When you face problems resulting from restenosis, it is important to find a center that has experienced doctors who are able to provide you with a broad range of treatment options.