Neoatherosclerosis after coronary stenting: mechanisms, diagnosis, and treatment

Despite significant advances in stent technology, long-term complications-such as restenosis and stent thrombosis-remain relatively common and clinically impactful due to their association with recurrent myocardial infarction and adverse outcomes. Among the causes of stent failure, neoatherosclerosis has gained recognition as a key pathological mechanism, driven by impaired vascular healing, chronic inflammation, platelet activation, and immune responses following coronary stenting. Advances in diagnostic accuracy, particularly intracoronary imaging, have provided new insights into its development. In response, emerging strategies-including refined pharmacotherapy, targeted intraprocedural interventions, novel stent designs, and alternative drug-delivery systems-are being explored. This review presents recent preclinical, diagnostic, and clinical advances in understanding and addressing neoatherosclerosis and discusses current and emerging therapeutic approaches (Graphical Abstract).