Angioplastie percutanee coronaire chez le patient diabetique. Partie 2: Espoirs apportes par les protheses endovasculaires.

Coronary artery revascularization procedures provide less favourable results in diabetic patients than in non-diabetic individuals. Especially, percutaneous coronary angioplasty (PTCA) is associated with a higher rate of restenosis and recurrence of cardiac morbidity and death. In diabetic patients, PTCA should, if possible, be combined with a stent. Bare-stents allow to reduce approximately by half the risk of restenosis, but unfortunately their efficacy decreases as the vessel diameter decreases, a common finding among diabetic patients with angiopathy. ARTS ("Arterial Revascularization Therapy Study") recently showed that diabetic patients have a worse prognosis even when bare-stents are combined with PTCA as compared to non-diabetic subjects and as compared to diabetic patients treated with coronary artery bypass graft. These results open new perspectives in favour of the use of drug-eluting stents containing pharmacological agents capable of preventing restenosis. Such new stents might improve the management of diabetic patients with coronary heart disease.