Coronary Restenosis; A Shifting Paradigm

Abstract

In this thesis, different modalities and treatment options for the treatment and prevention of coronary restenosis are discussed. All studied during the past 10 years in the clinical setting of the coronary catheterization laboratories in Utrecht. At first the initial results using intracoronary brachtytherapy with a liquid filled balloon are presented, as well as an in vitro study on the behaviour of platelets after brachytherapy. Secondly a comparison between direct and delayed brachytherapy is discussed. Thirdly a comparison between beta and gamma radiation and the first generation drug eluting stent is presented. Thereafter two chapters are dedicated to the incidence and risk of acute and sub acute stent thrombosis. A novel and revolutionary drug eluting stent design with in-situ customizable length and biodegradable polymer is presented in chapter 9. In two further chapters modified and new techniques in the treatment of coronary bifurcation lesions are discussed. And finally the results of a large retrospective local database analysis on a new thin strut cobalt chromium stent design and a decision tree for the indication of a bare metal stent in Utrecht are presented.