April 23, 2026Journal of the American College of Cardiology
In-Stent Restenosis in the Drug-Eluting Stent Era
Key result
DES ISR occurs in up to ~20% of patients and requires an algorithmic treatment approach.
Why the study?
The widespread implementation of drug-eluting stents and expanded percutaneous coronary intervention indications to high-risk patients and complex lesions introduced the clinical problem of drug-eluting stent in-stent restenosis.
Design
Review
Authors
Discussion
Loading...
Member takes
Implication
Supports algorithmic approach to symptomatic focal DES-ISR; leaves open optimal retreatment strategy pending randomized trials.
Key Points
- This research aims to address the issue of in-stent restenosis associated with drug-eluting stents in high-risk patients.
- Analysis of clinical presentations of DES ISR, including recurrent angina and acute coronary syndrome.
- Examination of mechanisms behind DES ISR, considering biological, mechanical, and technical factors.
- Proposed algorithm for treatment approaches based on intravascular imaging findings.
- In-stent restenosis rates vary from 3% to 20% among patients.
- Clinical symptoms include recurrent angina and acute coronary syndrome occurrences.
- A new treatment algorithm for managing DES restenosis is proposed based on current evidence.
Structured PICO
P
Population
Patients undergoing percutaneous coronary intervention with drug-eluting stents who develop in-stent restenosis
I
Intervention
Treatment approaches and intravascular imaging for drug-eluting stent in-stent restenosis
This review provides a comprehensive overview of the mechanisms, clinical presentation, and a proposed treatment algorithm for managing drug-eluting stent in-stent restenosis.
Cite This Study
Dangas et al. (2010) conducted a review in Drug-eluting stent in-stent restenosis. Drug-eluting stent (DES) was evaluated. Drug-eluting stent in-stent restenosis occurs in 3% to 20% of patients, presenting predominantly as focal restenosis with recurrent angina, and requires an algorithmic approach for treatment.