Key result
Intracoronary imaging guides individualized treatment for ISR persisting at ~2% annually despite modern DES.
Why the study?
Despite improvements in drug-eluting stent technologies, in-stent restenosis still occurs at 1%-2% per year, and mechanisms, imaging characterization, and treatment strategies have evolved.
Key Points
- This research aims to elucidate the mechanisms and treatment approaches for in-stent restenosis (ISR).
- Conducted a comprehensive review of ISR literature.
- Analyzed the incidence, mechanisms, and imaging techniques related to ISR.
- Proposed a contemporary treatment algorithm for ISR based on findings.
- ISR occurs at a rate of 1%-2% per year after stent implantation.
- Intracoronary imaging has enhanced understanding of ISR mechanisms.
- An individualized treatment approach is recommended based on imaging characterization.
Structured PICO
P
Population
Patients with coronary in-stent restenosis
I
Intervention
Intracoronary imaging and individualized treatment strategies
This review highlights the multifactorial mechanisms of in-stent restenosis and recommends an individualized treatment approach guided by intracoronary imaging.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
FAFernando AlfonsoInterventional cardiologist, Hospital Universitario de La Princesa, Madrid
“In-stent restenosis still remains a major clinical problem. Despite the advent of a new generation of drug-eluting stents, this will be the main cause of stent failure.”
SEStephen EllisInterventional cardiologist, Cleveland Clinic
“In-stent restenosis isn't particularly common, but it does happen. It seems that some patients are more prone to this than others, and we don't yet fully understand why that is.”
“As an interventional cardiologist, one of the biggest gaps that we've had in the coronary space in the United States was the lack of a drug-coated balloon to be able to treat patients with ISR. Traditionally when patients have stents that restenose, they're treated with another stent. But that means leaving behind another layer of metal within existing stents, and we generally don't want to put more and more layers of metal inside an artery, especially if we can avoid it.”
Implication
Supports imaging-guided individualized ISR therapy; leaves open novel prevention strategies for residual risk.
Abstract
The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Giustino et al. (2022) conducted a review in Coronary In-Stent Restenosis. Coronary in-stent restenosis continues to occur at a rate of 1%-2% per year despite advances in drug-eluting stent technologies, necessitating individualized treatment using intracoronary imaging.