Restenosis corticosteroids

Pepine CJ, Hirshfeld JW, Macdonald RG, et al. A controlled trial of corticosteroids to prevent restenosis after coronary angioplasty. M-HEART Group. Circulation 1990 81 1753-1761. 

Stone GW, Rutherford BD, McConahay DR, et al. A randomized trial of corticosteroids for the prevention of restenosis in 102 patients undergoing repeat coronary angioplasty. Cathet Cardiovasc Diagn 1989 18 227-231. 

In the past, several clinical studies with corticosteroids failed to demonstrate a significant reduction in coronary restenosis after percutaneous transluminal coronary angioplasty (35,36). However, as we mentioned previously, after balloon angioplasty, there were other mechanisms involved in the pathophysiology of coronary restenosis (such as acute wall recoil or chronic remodeling) that explained the negative results of those studies (35,36). 

These were the rationalities for the use of corticosteroids in clinical data in the prevention of restenosis (43),... 

Inflammatory response after stent implantation plays an important role in the cascade of neointimal formation. A positive correlation between inflammatory reaction and restenosis has been observed (16). Perivasculitis caused by stent deployment also participates in the neointimal formation (17). Corticosteroids, as an anti-inflammatory agent, have been evaluated. Methylprednisolone (MP)-loaded stents with different doses showed a positive dose-related effect on neointimal hyperplasia (18). Furthermore, MP-coated stents showed decreased macrophages at the stented sites (19). In clinic, dexamethasone-coated stents showed an inhibitive effect on neointimal hyperplasia in selected patients (20), although no beneficial effect was observed in a randomized trial compared to bare stents (21). For other type of drugs with anti-inflammatory characteristics, such as ibuprofen, colchicine, aton/astatin, and probucol, no favorable effects on neointimal hyperplasia were observed (18,22,23). 

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