The angiotensin II receptor blocker candesartan cilexetil reduces neointima proliferation after coronary stent implantation: A prospective randomized study under intravascular ultrasound guidance

Objectives The purpose of this study was to evaluate whether an angiotensin II receptor blocker, candesartan cilexetil, reduced neointima formation after coronary stent implantation by way of serial intravascular ultrasound analysis. Background Previous experimental studies have suggested that angiotensin II receptor blocker reduced neointima formation after vascular injury. However, it is unclear whether candesartan cilexetil has a similar effect on human coronary artery. Methods We recruited 50 consecutive patients with stable angina pectoris and 60 stenotic lesions. Patients were prospectively randomized into 2 groups: (1) 25 patients with 31 lesions received candesartan cilexetil (4-12 mg/d), and (2) 25 patients with 29 lesions did not receive the drug. Follow-up intravascular ultrasound was performed 6 m after the stent implantation. Cross-sectional images were obtained at 1-mm intervals within the stent, and the stent volume (SV), lumen volume (LV), and neointima volume (NV = SV − LV) were calculated using Simpsonʹs rule. The percentage neointima volume obstruction (%NV) was calculated as NV/SV × 100. Results Clinical and angiographic backgrounds were comparable between the 2 groups. At follow-up, the candesartan group had smaller SV and larger LV (SV, 156.3 ± 53.7 vs 165.4 ± 61.8 mm3, ns; LV, 122.2 ± 49.0 vs 113.1 ± 45.5 mm3, ns), and significantly smaller NV and significantly smaller %NV than the control group (NV, 34.2 ± 16.6 vs 52.3 ± 32.6 mm3, P < .01; %NV, 22.7 ± 10.9% vs 31.3 ± 13.4%, P < .01). Conclusions Candesartan treatment decreases neointima formation and hence may reduce in-stent restenosis.