GeneHealth - Your precision medicine

Coronary Restenosis

Disease Details

Family Health Simplified

Buy Membership

Description: Coronary restenosis is the re-narrowing of a coronary artery after it has been treated with angioplasty or stenting, typically due to excessive tissue growth at the site of the intervention.
Type: Coronary restenosis is generally not classified as a hereditary or genetically transmitted disease. It is a medical condition that occurs when an artery that was previously treated with procedures such as angioplasty or stenting becomes narrowed again. The risk factors are typically related to lifestyle, pre-existing medical conditions, or procedural factors rather than genetic transmission.
Signs And Symptoms: Signs and symptoms of coronary restenosis can include:

1. Chest pain or angina
2. Shortness of breath
3. Fatigue
4. Symptoms similar to those experienced before the initial coronary intervention

It's important to consult a healthcare professional for proper diagnosis and treatment.
Prognosis: Prognosis for coronary restenosis varies based on individual patient factors and the treatment approach used. It often recurs in about 20-30% of cases following balloon angioplasty, but this rate can be significantly reduced with the use of drug-eluting stents (DES), which release medication to inhibit tissue growth. Proper management with medications, lifestyle changes, and follow-up care can improve outcomes. Regular monitoring and potential re-intervention may be necessary to manage this condition effectively.
Onset: Coronary restenosis is a condition that manifests when a previously treated coronary artery becomes narrowed again. It typically occurs within 3 to 12 months following a percutaneous coronary intervention (PCI) such as angioplasty or stent placement. The onset is not instantaneous but develops gradually as the artery re-narrows.
Prevalence: The prevalence of coronary restenosis varies depending on the specific treatment modality used. After balloon angioplasty, the rate of restenosis can range from 30% to 50%. With the advent of bare-metal stents, the prevalence decreased to around 20% to 30%. Recent advancements, particularly with drug-eluting stents, have further reduced the rate of restenosis to approximately 5% to 10%.
Epidemiology: Coronary restenosis refers to the re-narrowing of an artery after it has been treated to remove a blockage, typically following procedures like angioplasty or stent placement.

Epidemiology:
- Coronary restenosis occurs in 20-30% of patients within the first 6 months after balloon angioplasty without stenting.
- With the use of bare-metal stents, restenosis rates reduce to about 15-20%.
- Drug-eluting stents have further decreased the incidence to approximately 5-10%.
- Restenosis is more common in patients with diabetes, smaller arteries, longer lesions, and complex atherosclerotic disease.
Intractability: Coronary restenosis refers to the re-narrowing of an artery after a procedure to remove a blockage, such as angioplasty or the placement of a stent. While it can be challenging to treat and manage, it is not considered entirely intractable. Various treatment options, including drug-eluting stents, medication, and lifestyle changes, have been developed to reduce the risk of restenosis and manage the condition effectively. Advances in medical technology and therapies continue to improve outcomes for patients experiencing coronary restenosis.
Disease Severity: Coronary restenosis can vary in severity based on the extent of artery re-narrowing after a procedure like angioplasty or stent placement. More severe cases might significantly reduce blood flow, potentially leading to chest pain or even a heart attack if left untreated. Regular follow-ups and imaging tests are crucial to monitor and manage the condition effectively.
Healthcare Professionals: Disease Ontology ID - DOID:4247
Pathophysiology: Coronary restenosis is the re-narrowing of a coronary artery after it has been treated with procedures like angioplasty or the placement of a stent.

**Pathophysiology:**
The process generally involves three key phases:
1. **Elastic Recoil:** Immediately after balloon angioplasty, the artery may partially recoil to its previous narrow state.
2. **Neointimal Hyperplasia:** The smooth muscle cells in the artery's inner layer proliferate and migrate, leading to thickening and narrowing of the arterial lumen.
3. **Chronic Inflammatory Response:** Persistent inflammation at the site of the stent or balloon injury leads to scarring and neointimal tissue formation, further contributing to the narrowing.

These mechanisms collectively result in the reduction of arterial diameter and recurrent symptoms of reduced blood flow to the heart muscle, potentially requiring repeat intervention.
Carrier Status: Coronary restenosis refers to the re-narrowing of a coronary artery after it has been treated with procedures such as angioplasty or stent placement. It is a complication rather than a condition caused by genetic factors, so the concept of "carrier status" does not apply to coronary restenosis.
Mechanism: Coronary restenosis is the re-narrowing of a coronary artery after it has been treated with procedures like angioplasty or stent placement.

**Mechanism:**
The primary mechanism involves the excessive proliferation and migration of vascular smooth muscle cells (VSMCs) into the arterial lumen, alongside the formation of neointimal tissue. This process results in the thickening of the arterial wall and subsequent narrowing of the vessel.

**Molecular Mechanisms:**
1. **Endothelial Injury and Dysfunction:** The initial mechanical injury to the endothelium during angioplasty or stenting disrupts the endothelial layer, leading to a cascade of inflammatory responses.
2. **Inflammatory Response:** Activated platelets and leukocytes release cytokines and growth factors (such as PDGF, TGF-β, and bFGF) that stimulate VSMC proliferation and migration to the site of injury.
3. **VSMC Activation:** Growth factors and cytokines activate signaling pathways in VSMCs, leading to their proliferation and migration. Key pathways include the PI3K/Akt pathway and the MAPK/ERK pathway.
4. **Extracellular Matrix Remodeling:** Matrix metalloproteinases (MMPs) degrade the extracellular matrix, allowing VSMCs to migrate and expand into the intimal layer.
5. **Neointimal Hyperplasia:** The combination of VSMC proliferation, migration, and extracellular matrix production leads to the formation of neointimal tissue, contributing to the re-narrowing of the artery.

Overall, coronary restenosis results from a complex interplay of mechanical, cellular, and molecular events following vascular injury.
Treatment: If restenosis occurs without a stent, it is usually treated with more angioplasty. This treatment is also used if restenosis occurs at either the proximal or distal end of the stent.If restenosis occurs within a stent (also known as in-stent stenosis), it may be treated with repeated angioplasty and insertion of another stent inside the original, often with a drug-eluting stent.Over the past 5 years, ISR has been increasingly treated with a drug-coated balloon (DCB), which is a balloon coated with the same anti-cancer drugs that prevent restenosis, such as Paclitaxel. The balloon avoids the need for a double layer of metal which is used when an in-stent restenosis is treated with another stent within the original stent. Additionally, DCB treatment does not leave an implant in the body and is designed for faster drug delivery.
Alternative treatments include brachytherapy, or intracoronary radiation. The radiation kills cells and inhibits tissue growth (similar to a patient undergoing cancer therapy).
Compassionate Use Treatment: Coronary restenosis refers to the re-narrowing of a coronary artery after it has been treated with procedures such as angioplasty or stenting. When conventional treatments are insufficient, some off-label or experimental options may be considered under compassionate use. These can include:

1. **Drug-Eluting Stents (DES)**: Although commonly used, newer versions or specific drugs within stents can sometimes be considered off-label.
2. **Sirolimus or Paclitaxel Delivery Systems**: Certain drug delivery mechanisms designed to inhibit cell proliferation can be used off-label.
3. **Bioresorbable Vascular Scaffolds**: These are stents that dissolve over time and are still under evaluation in many contexts.
4. **Lithoplasty**: A newer technique using sound waves to break up calcified plaque in the arteries prior to stenting may be considered experimental.
5. **Intracoronary Brachytherapy**: This involves the use of radiation to prevent cell proliferation and can be used in refractory cases.
6. **Innovative Drug Therapies**: Agents like anti-proliferative drugs that have not been fully approved for coronary restenosis can be used under compassionate use scenarios.
7. **Gene Therapy**: Experimental gene therapy to promote angiogenesis or inhibit negative remodeling processes in the arterial wall.

These treatments are typically only considered after thorough discussion with the patient and within regulatory guidelines due to their experimental status and potential risks.
Lifestyle Recommendations: For coronary restenosis, lifestyle recommendations include:

1. **Healthy Diet:** Focus on a heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit saturated fats, trans fats, cholesterol, sodium, and added sugars.

2. **Physical Activity:** Engage in regular physical activity, such as at least 150 minutes of moderate-intensity aerobic exercise per week, to improve cardiovascular health.

3. **Weight Management:** Maintain a healthy weight to reduce the strain on your heart and decrease the risk of further coronary artery disease.

4. **Smoking Cessation:** Quit smoking and avoid secondhand smoke to improve cardiovascular health and reduce the risk of restenosis.

5. **Manage Chronic Conditions:** Keep conditions like hypertension, diabetes, and high cholesterol under control through medication adherence and lifestyle changes.

6. **Limit Alcohol:** If you drink alcohol, do so in moderation. This generally means up to one drink per day for women and up to two drinks per day for men.

7. **Stress Management:** Employ stress-reducing techniques such as mindfulness, meditation, and yoga to support heart health.

8. **Regular Check-ups:** Attend all follow-up appointments with your healthcare provider to monitor and manage your heart health effectively.

These steps can help manage and potentially reduce the risk of coronary restenosis.
Medication: For coronary restenosis, medications that are often used include antiplatelet agents like aspirin and clopidogrel, and sometimes anticoagulants. These medications help prevent the formation of blood clots in the coronary arteries after procedures such as angioplasty or stent placement. Other medications might include statins to manage cholesterol levels, beta-blockers, and ACE inhibitors to help control blood pressure and reduce heart strain. Additionally, some drug-eluting stents release medication directly into the artery to help prevent restenosis. Always consult a healthcare provider for personalized treatment plans.
Repurposable Drugs: Coronary restenosis refers to the re-narrowing of an artery after it has been treated to remove a blockage. While research into repurposable drugs for coronary restenosis is ongoing, some drugs that have shown potential include:

1. **Sirolimus (Rapamycin)**: Originally used as an immunosuppressant, it is now commonly used in drug-eluting stents to prevent arterial re-narrowing.
2. **Paclitaxel**: Known for its role in cancer treatment, it is also used in drug-eluting stents due to its ability to inhibit cell proliferation.
3. **Statins (e.g., Atorvastatin, Simvastatin)**: These cholesterol-lowering drugs have anti-inflammatory properties that may help prevent restenosis.

The nan refers to no additional notable information regarding repurposable drugs outside commonly acknowledged treatments.
Metabolites: Coronary restenosis, the re-narrowing of an artery after it has been treated to remove blockages, is linked to various metabolites involved in inflammation, oxidative stress, and cellular proliferation. Key metabolites include reactive oxygen species (ROS), nitric oxide (NO), and various inflammatory peptides. These molecules play critical roles in the pathological processes leading to restenosis, such as endothelial dysfunction, smooth muscle cell proliferation, and extracellular matrix remodeling. Understanding these metabolites helps in developing targeted therapies to prevent restenosis after procedures like angioplasty or stent placement.
Nutraceuticals: Nutraceuticals, such as omega-3 fatty acids, antioxidants like vitamins C and E, and polyphenols found in foods like green tea and dark chocolate, are explored for their potential role in reducing coronary restenosis. They may help by reducing inflammation, improving endothelial function, and inhibiting the proliferation of vascular smooth muscle cells, which are contributing factors to restenosis. However, more research is needed to confirm their efficacy and optimal dosages for preventing restenosis.
Peptides: Coronary restenosis is the re-narrowing of an artery after it has been treated with procedures such as angioplasty or stent placement. Peptides are being explored for their potential to inhibit cellular mechanisms that contribute to restenosis, such as smooth muscle cell proliferation. Nanotechnology, especially in the form of nanoparticles and drug-eluting stents, is also being investigated to enhance drug delivery and reduce the likelihood of restenosis by providing more targeted, controlled, and sustained release of therapeutic agents.