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Renin-Angiotensin System Intervention to Prevent In-Stent Restenosis: An Unclosed Chapter

Langeveld, Bas MD*; Roks, Anton J. M. PhD*; Tio, Rene A. MD, PhD†; Voors, Adriaan A. MD, PhD†; Zijlstra, Felix MD, PhD†; van Gilst, Wiek H. PhD*

Journal of Cardiovascular Pharmacology:
Review Article

The occurrence of in-stent restenosis is a major drawback of percutaneous transluminal coronary angioplasty with stent placement. Target vessel revascularization is necessary in 15% of patients who receive a stent. Recent advances in the development of drug-eluting stents have reduced these numbers tremendously. However refinement of antirestenotic therapies remains obligatory. The emerging interest in more physiological antirestenotic therapies might unchain an interest in the well-known inhibitors of the rennin-angiotensin system (RAS), the angiotensin-converting enzyme inhibitors, and the angiotensin II type I receptor blockers. Contradictory results overshadow the discussion of whether intervention in the RAS could prevent in-stent restenosis. This review discusses the pathophysiology of in-stent restenosis, the role of the RAS in in-stent restenosis, and the possible role of RAS intervention in the prevention of in-stent restenosis.

Author Information

From the Departments of *Clinical Pharmacology and †Cardiology, University Hospital Groningen, Groningen, the Netherlands.

Received for publication April 28, 2004; accepted October 27, 2004.

Reprints: Bas Langeveld, Department of Clinical Pharmacology, University Hospital Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.