April 23, 2026Journal of the American College of Cardiology
Current Treatment of In-Stent Restenosis
Key result
Systematic review compares DES, DCBs, and alternative strategies for treating in-stent restenosis.
Why the study?
Management of patients with in-stent restenosis remains an important clinical problem, and treatment of drug-eluting stent ISR is particularly challenging.
What are the current therapeutic modalities and their efficacy for treating in-stent restenosis?
Population
Patients presenting with ISR within bare-metal stents or drug-eluting stents
Comparison
Currently available therapeutic modalities including drug-eluting stents and drug-coated balloons
Design
Systematic review of clinical trial data
Authors
Discussion
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Member takes
Implication
Clinicians should integrate intracoronary imaging to guide DES or DCB use in ISR; leaves open optimal combination therapies pending further trials.
Key Points
- To systematically review clinical trial evidence evaluating therapeutic modalities, including drug-eluting stents and drug-coated balloons, for treating in-stent restenosis in bare-metal and drug-eluting stents.
- Systematically evaluated clinical trial data evaluating interventions for in-stent restenosis in patients treated with bare-metal or drug-eluting stents.
- Assessed the application of intracoronary imaging modalities to identify underlying mechanical and biological failure mechanisms.
- Reviewed comparative treatment approaches, focusing primarily on repeat drug-eluting stent implantation and drug-coated balloon angioplasty.
- Neointimal proliferation represents the dominant cause of in-stent restenosis, with neoatherosclerosis identified as an important secondary substrate, especially in drug-eluting stent failures.
- Drug-eluting stents and drug-coated balloons provide effective therapeutic modalities for in-stent restenosis, though managing recurrence within drug-eluting stents presents greater clinical difficulty than bare-metal stents.
- Intracoronary imaging characterizes the precise tissue composition and structural mechanism of stent failure, facilitating tailored lesion preparation and repeat revascularization.
Study Design
Type
Systematic Review
Structured PICO
What are the current therapeutic modalities and their efficacy for treating in-stent restenosis?
P
Population
Patients presenting with in-stent restenosis (ISR) within bare-metal stents or drug-eluting stents
I
Intervention
Currently available therapeutic modalities, including drug-eluting stents (DES) and drug-coated balloons
This systematic review summarizes current therapeutic modalities, including drug-eluting stents and drug-coated balloons, for the management of in-stent restenosis.
Cite This Study
Alfonso et al. (2014) conducted a systematic review in In-stent restenosis. Drug-eluting stents and drug-coated balloons was evaluated. A systematic review evaluated currently available therapeutic modalities, including drug-eluting stents and drug-coated balloons, for the treatment of in-stent restenosis.