What does this research mean for the field?

Intracoronary imaging with IVUS or OCT significantly alters treatment strategies for in-stent restenosis by identifying underlying mechanical versus tissue-proliferative mechanisms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the impact of intracoronary imaging on identifying underlying mechanisms and modifying procedural and definitive treatment strategies during percutaneous coronary intervention for in-stent restenosis.

June 8, 2026Cardiology ResearchOpen Access

Role of Intracoronary Imaging in Percutaneous Coronary Intervention for In-Stent Restenosis: A Prospective Observational Study

Q: What are the key findings of this study?

Intracoronary imaging significantly modified the definitive treatment strategy for in-stent restenosis, increasing the use of drug-eluting stents from a planned 15% to an actual 50% (P = 0.021).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: In-stent restenosis (n=34). Intervention: Intracoronary imaging (IVUS or OCT) vs. Pre-imaging planned strategy (angiography alone). Primary outcome: Change in definitive treatment strategy (shift to DES implantation) (p=0.021).

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Key result

Intracoronary imaging during ISR PCI alters treatment strategy, increasing DES use by an absolute ~35%.

P=0.021
n=34

Why the study?

Coronary angiography has limited ability to identify the underlying mechanism of in-stent restenosis, so this study evaluated the impact of intracoronary imaging on mechanism identification and treatment strategy during PCI.

Does intracoronary imaging (IVUS or OCT) alter the definitive treatment strategy in patients undergoing PCI for in-stent restenosis?

Population

34 patients with 40 ISR lesions undergoing IVUS- or OCT-guided PCI at a tertiary care center

Design

Prospective observational study

Authors

RKRamya Das Nageri KunnathSree Chitra Thirunal Institute for Medical Sciences and Technology PVPulugundla VarunSree Chitra Thirunal Institute for Medical Sciences and Technology SNSharath NageshSree Chitra Thirunal Institute for Medical Sciences and Technology

Discussion

Member takes

Implication

May support imaging-guided DES escalation in ISR PCI; leaves open outcome impact in randomized trials.

Key Points

To assess the impact of intracoronary imaging on identifying underlying mechanisms and modifying procedural and definitive treatment strategies during percutaneous coronary intervention for in-stent restenosis.
Prospective observational study conducted between January 2025 and November 2025 at a single tertiary care center.
Included 34 patients with 40 in-stent restenosis (ISR) lesions involving 60 previously implanted stents undergoing IVUS- (82.5%) or OCT-guided (17.5%) percutaneous coronary intervention.
Classified lesions as mechanical or tissue-proliferative based on intravascular imaging and compared pre-imaging intended therapy with post-imaging executed treatment.
Intracoronary imaging identified mechanical and tissue-proliferative ISR mechanisms in equal proportions (50% each; 20 lesions per group).
Mechanical ISR presented earlier than tissue-proliferative ISR (presentation within 1 year in 80.0% vs 20.0%, P < 0.001) and involved stent overlap more frequently (65.0% vs 25.0%, P = 0.011).
Intravascular imaging led to lesion modification escalation in 50% of lesions and caused a significant treatment strategy shift, increasing drug-eluting stent implantation from a planned 15% to an executed 50% (P = 0.021).

Study Design

Type

Observational (n=34)

Multicenter

Structured PICO

Does intracoronary imaging (IVUS or OCT) alter the definitive treatment strategy in patients undergoing PCI for in-stent restenosis?

Population

34 patients (mean age 63.1 years, 17.6% female) with in-stent restenosis undergoing IVUS- or OCT-guided percutaneous coronary intervention, followed for a median of 4 months.

Exposure

Intracoronary imaging (IVUS or OCT) during ISR percutaneous coronary intervention (PCI)

Outcome

Impact of imaging on lesion preparation and definitive treatment strategysurrogate

Main Result

Absolute Event Rate: 50% vs 15%

p-value: p=0.021

Intracoronary imaging with IVUS or OCT significantly alters procedural planning and definitive treatment strategy in patients undergoing PCI for in-stent restenosis.

Limitations

Single-center observational study with a very small sample size
Very short clinical follow-up
Absence of a control group
Imaging modality selection and treatment strategy were based on operator discretion, introducing potential selection bias
Classification of mixed-mechanism lesions into two dominant categories may oversimplify the biological and mechanical continuum of ISR
Small sample size
Lack of long-term clinical follow-up
Lack of comparative control group

Cite This Study

Kunnath et al. (2026) conducted an observational in In-stent restenosis (n=34). Intracoronary imaging (IVUS or OCT) vs. Pre-imaging planned strategy (angiography alone) was evaluated on Change in definitive treatment strategy (shift to DES implantation) (p=0.021). Intracoronary imaging significantly modified the definitive treatment strategy for in-stent restenosis, increasing the use of drug-eluting stents from a planned 15% to an actual 50% (P = 0.021).

synapsesocial.com/papers/6a265bb6ad53cfb9357c5230 https://doi.org/10.14740/cr2224

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Role of Intracoronary Imaging in Percutaneous Coronary Intervention for In-Stent Restenosis: A Prospective Observational Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Role of Intracoronary Imaging in Percutaneous Coronary Intervention for In-Stent Restenosis: A Prospective Observational Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider