Coronary in-stent restenosis continues to occur at a rate of 1%-2% per year despite advances in drug-eluting stent technologies, necessitating individualized treatment using intracoronary imaging.
This review highlights the multifactorial mechanisms of in-stent restenosis and recommends an individualized treatment approach guided by intracoronary imaging.
The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.
“In-stent restenosis still remains a major clinical problem. Despite the advent of a new generation of drug-eluting stents, this will be the main cause of stent failure.”
Giustino et al. (Fri,) conducted a review in Coronary In-Stent Restenosis. Coronary in-stent restenosis continues to occur at a rate of 1%-2% per year despite advances in drug-eluting stent technologies, necessitating individualized treatment using intracoronary imaging.