What Is the Clinical and Economic Impact of Restenosis?
The major benefit of DES is a reduction in the rate of restenosis after PCI. Therefore, to understand the clinical and economic impact of DES, the overall scope and consequences of coronary restenosis must first be appreciated. Unlike native coronary artery stenoses in which plaque rupture and in situ coronary thrombosis can lead to acute myocardial infarction or death, in-stent restenosis is largely a nonfatal condition.10 Luminal narrowing after BMS implantation occurs from neointimal hyperplasia and vascular remodeling mainly at the stent margins.11 This process causes gradual, progressive loss of arterial diameter, resulting most commonly in recurrent myocardial ischemia and anginal symptoms. Given the gradual nature of the disease process, progression to myocardial infarction or sudden cardiac death is very rare.10 Several clinical studies confirm the relatively benign long-term prognosis of patients who experience coronary restenosis. Weintraub and colleagues12 followed-up >3300
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