This Article Full Text (PDF) All Versions of this Article: 0003319707305962v1 58/6/710    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Schindler, C. Articles by Schweizer, J. Search for Related Content PubMed PubMed Citation Articles by Schindler, C. Articles by Schweizer, J. Social Bookmarking                         What's this?

Comparison of Selective AT₁-Receptor Blockade Versus ACE Inhibition for Restenosis Prophylaxis in Patients With Peripheral Occlusive Arterial Disease After Stent Angioplasty: A Randomized, Controlled, Proof-of-Concept Study

Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany, christoph.schindler{at}tu-dresden.de, chrschin{at}aol.com

Axel Mueller, MD

Clinic for Internal Medicine 1, Department of Cardiology and Angiology, Chemnitz Hospital, Germany

Peter Bramlage, MD

Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany

Wolfgang Boecking, MD

Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany

Wilhelm Kirch, MD, PhD

Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany

Johannes Schweizer, MD

Clinic for Internal Medicine 1, Department of Cardiology and Angiology, Chemnitz Hospital, Germany

Different components of the renin-angiotensin system (RAS) have been demonstrated in atherosclerotic plaques. However, the involvement of the RAS in the complex process of in-stent restenosis is not yet clear. In this prospective, randomized, double-blind, controlled proof-of-concept study, we compared the 2 different pharmacological approaches, selective AT₁-receptor-blockade with candesartan vs ACE inhibition with quinapril to reduce in-stent restenosis after stent angioplasty of the superficial femoral artery. Twenty-two hypertensive patients with stage IIb peripheral occlusive arterial disease and severe claudication who had been successfully treated with percutaneous transluminal angioplasty (PTA) and stent implantation were randomly assigned to receive daily doses of either candesartan (32 mg) or quinapril (20 mg). Primary end point was restenosis 6 months after intervention, assessed by angiography. Secondary end points were pain-free walking distance, determined by treadmill ergometry; determination of crurobrachial indices; and intima-media thickness (IMT). At 6 months, the rate of restenosis on angiography was 34% in the candesartan group and 71% in the quinapril group (P = .043). Relevant restenosis was found in 3 patients (27%) in the candesartan group and in 7 patients (64%) in the quinapril group. Patients in the candesartan group were able to walk farther on a treadmill (increase: 135 m ± 20 m) compared with patients in the quinapril group (increase: 83 m ± 21 m). The IMT at the stent edge was not significantly different in the 2 groups (candesartan: 1.9 mm ± 0.5 mm; quinapril: 2.0 mm ± 0.3 mm). This study revealed significant benefit of a pharmacological restenosis regimen using the AT₁-receptor antagonist candesartan in patients with severe atherosclerosis after superficial femoral artery stenting compared with treatment with the ACE inhibitor quinapril. Further prospective studies in patients are required to confirm these results.

This version was published on January 1, 2008

Angiology, Vol. 58, No. 6, 710-716 (2008)
DOI: 10.1177/0003319707305962


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?