Restenosis: A Guide to Therapy
David P. Faxon, ed.
279 pp. London: Martin Dunitz; 2001. $125.00. ISBN: 1-85317-897-7
Since Dr Andreas Gruntzig’s original coronary angioplasty was first performed more than 20 years ago, percutaneous coronary interventions have become the most common method of coronary revascularization in the United States. A broad variety of new, highly sophisticated technologies have evolved over the past 20 years to make this revolution possible. Despite these enormous advancements, however, the Achilles heel for all percutaneous coronary interventions remains restenosis. Although the concept of restenosis is simple — the artery re-closes over time after it is initially successfully opened — myriad challenging nuances exist that make this problem both complex and mystifying. Most importantly, no adequate and effective solution to the problem of restenosis has been developed, although a variety of potentially very effective approaches have been proposed. Because of the tremendous importance that restenosis plays in interventional cardiology, it is most appropriate that a textbook be published targeting this single subject. The textbook Restenosis: A Guide to Therapy, edited by David P. Faxon, provides an excellent synopsis of this important subject, with chapters written by internationally recognized leaders in the field. The textbook covers a wide range of restenosis-related topics, ranging from the pathophysiology of restenosis to the exciting new developments in its treatment. The chapters are well written and clinically relevant. Although the authors do not shy away from discussion of the more basic and complex aspects of their subjects, in general, they have successfully produced chapters that are understandable by virtually any well-informed reader. Although it addresses the latest research developments in the management of restenosis, this textbook also provides basic guidelines related to the present standard of care for treatment of patients with restenosis. For instance, the textbook includes excellent guidelines for the appropriate clinical follow-up of post-interventional patients for the identification of restenosis and the utilization of stent therapy to reduce restenosis, as well as recommendations for the appropriate use of the recently available technology of brachytherapy. By these discussions, this book becomes an excellent guide for the up-to-date management of today’s patients and also helps the reader understand the potential importance of various possible future developments. Each chapter is well referenced, with appropriate and generally up-to-date references. I did notice that some of the references, however, were not the primary source, but rather referenced other cardiovascular textbooks.
The book is 279 pages long, but is rapid and interesting reading. Although it covers all the important aspects of restenosis, it might have been appropriate to expand the scope of the text even further in some areas. For instance, the discussion of the pathophysiology of restenosis could be more detailed to include the monoclonal hypothesis of restenosis linked to exposure by cytomegalovirus and its effects on P-53. Also, the field of drug coatings on coronary stents has exploded over the past several years, and a broad variety of potentially active agents are being considered. Rapamycin and paclitaxel were well described, but other agents, such as actinomycin-D and batimastat, might also deserve discussion. Likewise, in the discussion on treatment of in-stent restenosis, the use of cutting balloon therapy, an approach that is becoming more popular all the time, might have deserved more discussion. Also, cryotherapy, a newly proposed approach to the treatment of restenosis, might have been included. Despite these minor limitations, however, this book contains a wealth of information of practical importance to all physicians who care for patients with coronary artery disease. As the number of percutaneous coronary interventions increase, challenges associated with restenosis will be more pervasive throughout all of our practices. Careful reading of this textbook will greatly enhance each of our knowledge and understanding of this complex subject and prepare us for future treatments to come.