Charles Nicolais1, Vladimir Lakhter1, Hafeez Ul Hassan Virk2, Partha Sardar3, Chirag Bavishi4, Brian O'Murchu1, Saurav Chatterjee5. 1. Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. 2. Division of Cardiovascular Diseases, Albert Einstein Health Center, Philadelphia, PA, USA. 3. Division of Cardiovascular Diseases, University of Utah Health Sciences Center, Salt Lake City, UT, USA. 4. Division of Cardiovascular Diseases, Mount Sinai St Luke's-West Hospitals, New York, NY, USA. 5. Division of Cardiovascular Diseases, St Francis Hospital-Hoffman Heart Center, Teaching affiliate, University of Connecticut School of Medicine, Farmington, CT, USA. sauravchatterjeemd@gmail.com.
Abstract
PURPOSE OF REVIEW: In-stent restenosis (ISR) is a complex disease process that became apparent shortly after the introduction of stents into clinical practice. This review seeks to define in-stent restenosis (ISR) as well as to summarize the major treatment options that have been developed and studied over the past two decades. RECENT FINDINGS: Recent developments in drug-coated balloons and bioresorbable vascular scaffolds have added new potential treatments for ISR. Two recent network meta-analyses performed a head-to-head comparison of all the various treatment modalities in order to identify the best approach to management of ISR. Current data suggests that repeat stenting with second-generation drug-eluting stents is most likely to lead to the best angiographic and clinical outcomes. In situations where repeat stenting is not preferable, drug-coated balloon therapy seems to be a reasonably effective alternative.
PURPOSE OF REVIEW: In-stent restenosis (ISR) is a complex disease process that became apparent shortly after the introduction of stents into clinical practice. This review seeks to define in-stent restenosis (ISR) as well as to summarize the major treatment options that have been developed and studied over the past two decades. RECENT FINDINGS: Recent developments in drug-coated balloons and bioresorbable vascular scaffolds have added new potential treatments for ISR. Two recent network meta-analyses performed a head-to-head comparison of all the various treatment modalities in order to identify the best approach to management of ISR. Current data suggests that repeat stenting with second-generation drug-eluting stents is most likely to lead to the best angiographic and clinical outcomes. In situations where repeat stenting is not preferable, drug-coated balloon therapy seems to be a reasonably effective alternative.
Entities:
Keywords:
Balloon angioplasty; Bare metal stent; Drug-eluting stent; In-stent restenosis; Neo atherosclerosis; Rotational atherectomy
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