Introduction
Stenosis refers to the blockage or narrowing of a blood vessel. Medical professionals carry out an angioplasty procedure to treat coronary artery disease (CAD). During an angioplasty, small tubes made of wire mesh called stents may be put into arteries blocked by coronary artery disease. These treatments increase blood flow through the blood vessel (artery). Restenosis occurs when the opened, treated artery closes up once again. In-stent restenosis occurs when a blockage or narrowing comes back in the part of the coronary artery where a stent was used.
What Causes Restenosis?
Overgrowth of scar tissue is the root cause of restenosis. New tissue forms inside the stent after inserting it into a blood artery, covering the struts. Initially, this new tissue is made up of healthy cells from the endothelium of the artery wall. This is a positive impact because it prevents the formation of blood clots in the stented area by allowing normal tissue to grow over the stent. However, scar tissue may form beneath the new healthy lining, obstructing blood flow.
After stenting and angioplasty, tissue forms over the stent to provide a new lining for the artery wall. This lining makes blood flow more easily, which reduces the possibility that a blood clot may develop inside the stent. Scar tissue usually develops below this lining. However, if there is excessive scar tissue, the artery's lining may become very thick and restrict blood flow again. In-stent restenosis is most common 3 to 6 months after the surgery; after 12 months, it is uncommon.
Who Is at High Risk for Restenosis?
Restenosis can happen to anyone with angioplasty and stenting to treat coronary artery disease. People may be more susceptible to acquiring restenosis if they have the following:
-
High cholesterol.
-
Chronic kidney disease.
-
Mental allergy.
-
Multi-vessel coronary artery disease.
-
Uncontrolled diabetes.
-
Hypertension (high blood pressure).
-
Inflammatory response to the medication.
-
Smoking.
What Are the Symptoms of Restenosis?
Restenosis occurs 3 to 6 months after the stent is placed. Diabetes patients may experience fewer, unusual, or no symptoms. Restenosis symptoms are likely to be the same as CAD symptoms, which may include:
-
Chest pain and discomfort.
-
Nausea.
-
Fatigue.
-
Weakness.
-
Shortness of breath.
-
Fast or irregular heartbeat.
-
Sweating.
-
Dizziness.
-
Shoulder or arm pain.
How Is Restenosis Diagnosed?
If the doctor suspects restenosis, he may suggest certain tests. These tests aid in understanding more about the blockage's size, location, and other characteristics. It includes:
-
Exercise Stress - To determine how well the heart pumps blood during exertion.
-
Coronary Angiogram - To identify blockages and demonstrate how well the blood flows on an X-ray when dye is injected into the artery.
-
Intravascular Ultrasound - Sound waves are emitted via the catheter to produce a picture of the inside of the artery.
-
Optical Coherence Tomography - High-resolution images of the interior of the artery are produced using light waves that are emitted via a catheter.
What Is the Treatment for Restenosis?
There are many treatment options available for restenosis. A doctor will choose the best course of treatment based on the severity of the restenosis. For example, healthcare professionals might recommend one of the following treatments:
-
Medications - A doctor may recommend sirolimus or cilostazol if the patient develops restenosis in the same location more than twice. These drugs aid in reducing the accumulation of tissue in the artery.
-
Re-stenting - It could be necessary to use a high-pressure balloon to re-expand the stent if it was implanted improperly or did not expand properly. If the problem is tissue overgrowth, another stent may be required.
-
Retrograde Approach - Blood vessels are moved around the obstruction during this treatment. It includes using new blood vessels that develop after a severely constricted artery.
-
Heart Bypass Surgery -This surgical treatment is known as coronary artery bypass grafting or CABG. It uses healthy blood arteries from other body parts to bypass the blocked part of the artery. The blood vessel will have one end attached above the obstruction and one below it.
-
Brachytherapy - It is a kind of radiation therapy. For about 10 minutes, radiation is delivered directly to the inside of the artery. This can help stop tissue from growing in the artery again, stopping restenosis from happening again.
-
Percutaneous Technique- The doctor might use a percutaneous technique to clear the obstruction if the patient has a complete blockage. This is accomplished through a skin incision. The blockage is then removed using catheters and guidewires.
How Can Restenosis Be Prevented?
People with restenosis may be more prone to life-threatening heart problems, including unstable angina, acute coronary syndrome, and heart attacks. To prevent or lower the risk of restenosis, doctors may suggest the following steps:
-
Eating A Healthy Diet - Consuming a well-balanced diet is one of the most effective methods to prevent and reverse heart disease.
-
Manage Blood Pressure - Take the recommended drugs for high blood pressure management and reduce sodium intake.
-
Control Cholesterol Level - Limit the intake of trans and saturated fat intake since they contribute to plaque formation, which can clog the arteries.
-
Maintain Blood Sugar - Maintaining the blood sugar level is necessary because it can harm organs.
-
Be Physically Active - Maintaining an active life and doing enough exercise can lengthen life and improve the quality of life.
-
Keep A Healthy Weight - Maintain a healthy weight because excess weight can put pressure on the lungs, heart, skeleton, and blood vessels.
-
Avoid Smoking - Limit or avoid smoking cigarettes as it raises the risk of developing heart disease.
-
Avoid Intake of Alcohol - Moderately consume alcohol and seek treatment for alcohol use disorders.
Conclusion
Because of new technologies, the chance of getting restenosis from tissue overgrowth after angioplasty or stenting has decreased significantly. People with coronary artery disease may experience chest pain, fatigue, or shortness of breath that can indicate restenosis. Consult a medical professional if any symptoms occur. However, a healthy lifestyle can help prevent this condition.
