What does this research mean for the field?

Effective management of coronary in-stent restenosis requires a mechanism-guided, substrate-driven approach that integrates intracoronary imaging and tailored therapies such as drug-coated balloons or repeat stenting. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This review aims to summarize current management strategies for coronary in-stent restenosis (ISR) based on underlying mechanisms and risk factors.

July 8, 2026Journal of Clinical MedicineOpen Access

Practical Management in Coronary In-Stent Restenosis: A Narrative Review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Coronary in-stent restenosis (ISR). Intervention: Mechanism-guided management strategies.

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Key result

Mechanism-guided management of in-stent restenosis emphasizes intracoronary imaging and tailored treatments like drug-coated balloons.

Why the study?

Coronary in-stent restenosis remains a major cause of repeat revascularisation despite advances in drug-eluting stent technology, requiring a mechanism-guided approach to treatment selection.

Design

Narrative review

Authors

HSHandi Y. SalimNew Cross Hospital ATA. TahirNew Cross Hospital WTWen Hui TehPapworth Hospital NHS Foundation Trust

Discussion

Member takes

Implication

Supports mechanism-guided ISR management in practice; extends 2023-2024 classifications and guidelines with updated synthesis.

Key Points

This review aims to summarize current management strategies for coronary in-stent restenosis (ISR) based on underlying mechanisms and risk factors.
Examined definitions, incidence, and classification of ISR using Mehran, Waksman, and SCAI frameworks.
Reviewed evidence-based treatment strategies like drug-coated balloons, repeat DES implantation, and vascular brachytherapy.
Outlined patient-related, procedural, anatomical, and stent-related risk factors influencing ISR management.
Evidence supports the use of imaging modalities like IVUS and OCT for ISR characterization and treatment planning.
Decision-making between drug-coated balloons and repeat DES entails consideration of ISR type and lesion characteristics.
Future priorities emphasize the need for ISR-specific randomized trials and validation of imaging-guided treatment algorithms.

Structured PICO

Population

Patients with coronary in-stent restenosis (ISR)

Intervention

Mechanism-guided management strategies including intracoronary imaging (IVUS/OCT) and treatments (drug-coated balloons, repeat DES, lesion-modifying therapies, vascular brachytherapy, CABG)

This review provides a contemporary, mechanism-guided framework for managing coronary in-stent restenosis, emphasizing intracoronary imaging and tailored therapies like drug-coated balloons and repeat stenting.

Limitations

Recommendations for imaging use are based largely on observational and surrogate-endpoint data rather than ISR-specific randomized trials demonstrating reductions in hard clinical outcomes
Practical barriers to imaging include cost, availability, and operator expertise
Lack of ISR-specific randomised trials demonstrating reductions in hard clinical outcomes for imaging
Practical barriers to imaging including cost, availability, and operator expertise

Cite This Study

Salim et al. (2026) conducted a review in Coronary in-stent restenosis (ISR). Mechanism-guided management strategies was evaluated. This narrative review outlines a mechanism-guided approach to managing coronary in-stent restenosis, emphasizing intracoronary imaging and tailored treatments like drug-coated balloons and repeat DES.

synapsesocial.com/papers/6a4de8ebd2ea289ef62835a3 https://doi.org/10.3390/jcm15135250

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Practical Management in Coronary In-Stent Restenosis: A Narrative Review

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Practical Management in Coronary In-Stent Restenosis: A Narrative Review

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

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