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What to Know About Restenosis

Medically Reviewed by Dan Brennan, MD on June 13, 2021

Restenosis occurs when an artery that was opened with a stent or angioplasty becomes narrowed again. Atherosclerosis is the buildup of fatty deposits and cholesterol inside of your arteries. This buildup can limit the blood supply to your heart. Stents are often put in place to open the artery so blood can flow freely to the heart again. When this area narrows again, it's called restenosis.

What Are the Symptoms of Restenosis?

The symptoms of restenosis will probably be similar to your original symptoms of atherosclerosis, which can include:

Restenosis generally occurs within 3 to 6 months after your stent is placed. It's unusual for it to happen more than 12 months after the procedure. People who have diabetes may have fewer symptoms, unusual symptoms, or no symptoms.

What Causes Restenosis?

Restenosis is caused by an overgrowth of scar tissue. When a stent is first placed, healthy tissue from the lining of your cell walls grows inside of it. This is good because it keeps your blood from clotting as it flows through the stent. However, scar tissue may form underneath the healthy tissue. In some cases, the scar tissue may grow so thick that it obstructs the flow of blood. 

What Are Risk Factors for Restenosis?

Between 3% and 20% of people who have a drug-eluting stent develop restenosis. A drug-eluting stent slowly releases medicine to help stop the tissue buildup that causes restenosis. Between 16% and 44% of people with bare-metal stents develop restenosis. Bare-metal stents don't have this medicine.

You may have a higher risk of developing restenosis if you:

  • Have diabetes
  • Have chronic kidney disease
  • Have a metal allergy
  • Are female
  • Have multi-vessel coronary artery disease, which is when two or more of your heart arteries are significantly narrowed
  • Are older
  • Have an inflammatory response to the medicine in the drug-eluting stent

How Is Restenosis Treated?

There are many different options for treating restenosis. You will meet with a cardiac interventionist, who is a doctor who does procedures to open arteries. Your doctor can determine the best course of treatment for you based on your individual circumstances. Some options may include:

Re-stenting. If your stent was not put in correctly or didn't expand correctly, your stent may need to be re-expanded with a high-pressure balloon. If the problem is an overgrowth of tissue, another stent may need to be placed.

Medicine. If you've had restenosis more than twice in the same area, your doctor may prescribe sirolimus or cilostazol. These medicines help to reduce the amount of tissue that builds up in your artery.

Brachytherapy. This is a type of radiation therapy. It delivers radiation directly to the inside of the artery for about 10 minutes. This can help prevent future tissue growth in the artery so that restenosis won't happen again.

Coronary artery bypass graft surgery. This surgery uses healthy blood vessels from other parts of your body to go around the blocked portion of the artery. One end of the blood vessel will be attached below the blockage, and one end will be attached above the blockage. 

Percutaneous technique. If you have a total blockage, your doctor may do a percutaneous technique to clear it. This is done with an incision in the skin. Then guidewires and catheters are used to clear the blockage.

Retrograde approach. This treatment moves blood vessels around the blockage. It involves using new blood vessels that form when an artery is severely narrowed. 

How to Prevent Restenosis

People who follow the American Heart Association Life's Simple 7 plan have a lower risk of restenosis. These guidelines outline seven risk factors for cardiovascular disease that people control through lifestyle changes.

Life's Simple 7 include the following steps:

  • Maintain your blood pressure in a healthy range. High blood pressure puts a strain on your heart, arteries, and kidneys.
  • Control your cholesterol. High cholesterol leads to a buildup of plaque that can clog your arteries.
  • Reduce your blood sugar. High blood sugar can damage your organs.
  • Stay active. Getting enough exercise will help you live longer and increase your quality of life.
  • Eat a healthy diet. A heart-healthy diet is one of the most effective ways to prevent and reverse heart disease.
  • Lose weight. Excess weight strains your heart, lungs, skeleton, and blood vessels.
  • Stop smoking. Smoking increases your risk of heart disease.

Show Sources

SOURCES:

American Heart Association: "My Life Check | Life's Simple 7."

Beaumont Health: "Understanding restenosis."

Biomed Research International: "Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization."

Circulation: "Restenosis: Repeat Narrowing of a Coronary Artery."

Cleveland Clinic: "CAD: In-Stent Restenosis," "Coronary Artery Disease."

Johns Hopkins Medicine: "Coronary Artery Bypass Graft Surgery."

Journal of the American College of Cardiology: "Current Treatment of In-Stent Restenosis."

World Journal of Cardiology: "Diagnosis and management challenges of in-stent restenosis in coronary arteries."

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