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The contemporary issue of in-stent restenosis is reviewed in the article. The widespread use of interventional technologies for the treatment of acute and chronic forms of ischemic heart disease led to the appearance of the problem of coronary artery restenosis at the implantation site. The problem was apparently solved through introduction of drug-eluting stents instead of bare-metal stents. However, these stents also led to restenosis, but in more remote period. The issue of the contemporary cardiology is how to avoid this complication. Risk stratification of restenosis development in various groups of patients is a main task today, as the treatment of this condition is not simple. The article analyzes data of the studies conducted up to date. It studies the pathogenetic mechanisms that would develop restenosis of the previously stented coronary arteries (in various stents) and factors contributing to the formation of restenosis. The results of the studies show that vasculoendothelial growth factor-A (VEFR-A) plays a role in the development of restenosis and might predict the formation of this complication. The review addresses the issues of different genotypes of VEFR-A, which may predispose to the formation of stent restenosis.

Purpose. The aim of the trial was to study the importance of immuno-inflammatory processes and hemo-rheological changes in patients suffering from stable coronary heart disease after coronary angioplasty and stenting, as well as establishing the clinical effect of treatment optimized with anti-inflammatory drugs and immune-correctors.Material and methods. The study included 103 patients in total and 64 patients with an implanted stent. Within 2-28 months after stent implantation, an angiographic study was performed with the definition of a coagulogram, C-reactive protein (CRP), fibrinogen, and pro-inflammatory cytokines - tumor necrosis factor (FNA-α), interleukins (IL), IL-6, IL-8 in the serum of patients with coronary artery disease.Results. After coronary angioplasty and stenting in patients with coronary artery disease, the average concentrations of CRP and cytokines were significantly higher compared with both the control group and the group without restenosis. This indicator in the groups with and without restenosis was 16.4±1.2 (intragroup variation 6-36) mg/L and 6.8±0.4 (intragroup variation 5-10) mg/L, respectively; p

Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need.Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting.Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis.Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.

Aim of the study is to show the pathogenetic importance of myocardial revascularization and to estimate quantitatively effi ciency of the treatment of cardiac allograft vasculopathy after heart transplantation.Materials and methods. 30 percutaneous coronary interventions (PCI) were performed to recipients of heart transplant (8 men and 7 women, aged from 18 to 56 years), who were diagnosed with cardiac allograft vasculopathy by coronary angiography within the time period from 1,5 to 12 years after heart transplantation. Before revascularization and one week after tolerances to physical activity, volume characteristics of the left ventricle were defi ned and diastolic function of heart was estimated. Average term of observation after stenting was 35,5 ± 5,5 months.Results. Tolerance to physical activity (from 76,6 ± 8,5 to 116,9 ± 9,6 W), its duration (from 5,4 ± 2,2 to 8,5 ± 4,1 min) and rate pressure product – RPP (from 198 ± 15 to 247 ± 24 P < 0,05) increased. There was a restoration of diastolic function (Ve/Va from 0,57 ± 0,18 to 1,15 ± 0,2 P < 0,05). Signifi cant distinction in time frames of vasculopathy development, frequency and reasons of repeated interventions depending on age of patients is revealed. In the group of patients younger than 30 years of age (7 patients), the time interval between heart transplantation and vasculopathy development is twice shorter, than in more senior patient group, over 45 years old (8 patients). Young patients showed the expressed tendency to develop stent restenosis (20 coronary interventions).Conclusion. Dynamics in functional condition of the left ventricle as a result of revascularization confi rms the leading role of miocardial ischemia in pathogenesis of transplant insuffi ciency due to vasculopathy. The signifi cant factor infl uencing upon long-term result of coronary intervention is the age of the patient.