This review highlights that DES-ISR remains a significant clinical issue and that drug-coated balloons and repeat DES implantation are the most effective current treatments, though optimal management requires further large randomized trials.
Implantation of coronary drug-eluting stent (DES) became a predominant therapeutic strategy for coronary artery disease. One of the possible complications after DES implantation is in-stent restenosis (ISR) and today it becomes a significant issue for interventional cardiologists that requires further sustained and efficacious treatment. Widely accepted classification of DES-ISR is morphological classification proposed by Mehran et al. Currently available and effective therapeutic approach for DES-ISR include conventional balloon angioplasty, cutting or scoring balloon angioplasty, drug-coated/drugeluting balloon angioplasty (DCB/DEB), DES in DES stenting (same or different), vascular brachytherapy and coronary artery bypass grafting (CABG). However, optimal treatment for DES-ISR remains unknown. Bioresorbable vascular scaffolds (BVS) offer initial hope, but further clinical studies are required to establish their long-term efficacy and safety.
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