Percutaneous transluminal coronary angioplasty (PTCA) in diabetic patients. Part 1: failure due to restenosis after simple PTCA

peer reviewedDiabetes mellitus, essentially type 2 diabetes, is markedly associated with a high risk of cardiovascular diseases, especially coronary artery disease (CAD). Revascularization techniques, first coronary artery bypass graft (CABG) and second percutaneous transluminal coronary angioplasty (PTCA), have drastically changed the management of patients with CAD. Unfortunately, overall results of such revascularization procedures are less impressive in diabetic patients than in nondiabetic subjects, because of a worse vascular bed due to a more diffuse disease including small vessels. The diabetic population is indeed characterized by higher rates of both post-CABG thrombosis and post-PTCA restenosis, as compared to the corresponding rates observed in a nondiabetic population. Such vascular complications result in a higher incidence of coronary events leading to greater morbidity and mortality in both the short (weeks-months) and long (years) term. The bad quality of blood glucose control appears to play a crucial role in the risk of restenosis and further complications. The use of endovascular stents, especially new drug-eluting stents reducing the risk of restenosis, may represent a new opportunity for the management of a high-risk population such as diabetic patients