In-stent restenosis

Abstract

Even after optimal immediate results, restenosis still occurs in a relevant percentage of patients after stent implantation. This disappointing outcome has strong clinical and socio-economical implications and has become a major target of research in cardiology. The conceptual difference between the mere resolution of the restenotic lesion and the understanding of the mechanisms of restenosis creates a dichotomy between daily practice in the catheterization laboratory and questions raised in the research laboratory that commonly divides people (clinicians and researchers) and budgets (industries and academic institutions). As a consequence, efforts are aimed at treating the consequences of unsuccessful stenting on the one hand, and to understand the causes of excessive neointimal proliferation on the other. However, the commitment of researchers and the large clinical experience accumulated in these years are by-products of the symbiosis between manufacturers and scientists, and it seems as though the fight against restenosis is about to be won with the further setting-up of adequate means that act effectively on the target, even though it has not been clearly understood or identified. Such a pragmatic position, although possibly effective, should remind us that the ancient peoples used natural medicines to cure diseases that they never understood.