BACKGROUND: Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations. RESULTS: The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]). CONCLUSION: Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it.
BACKGROUND: Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations. RESULTS: The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]). CONCLUSION: Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it.
Authors: Jürgen Pache; Adnan Kastrati; Julinda Mehilli; Helmut Schühlen; Franz Dotzer; Jörg Hausleiter; Martin Fleckenstein; Franz Josef Neumann; Ulrich Sattelberger; Claus Schmitt; Martina Müller; Josef Dirschinger; Albert Schömig Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: Juan Torrado; Leo Buckley; Ariel Durán; Pedro Trujillo; Stefano Toldo; Juan Valle Raleigh; Antonio Abbate; Giuseppe Biondi-Zoccai; Luis A Guzmán Journal: J Am Coll Cardiol Date: 2018-04-17 Impact factor: 24.094
Authors: Lorenz Räber; Lea Wohlwend; Mathias Wigger; Mario Togni; Simon Wandel; Peter Wenaweser; Stéphane Cook; Aris Moschovitis; Rolf Vogel; Bindu Kalesan; Christian Seiler; Franz Eberli; Thomas F Lüscher; Bernhard Meier; Peter Jüni; Stephan Windecker Journal: Circulation Date: 2011-06-06 Impact factor: 29.690
Authors: Fernando Alfonso; María Jose Pérez-Vizcayno; Alberto Cárdenas; Bruno García del Blanco; Arturo García-Touchard; José Ramón López-Minguéz; Amparo Benedicto; Mónica Masotti; Javier Zueco; Andrés Iñiguez; Maite Velázquez; Raúl Moreno; Vicente Mainar; Antonio Domínguez; Francisco Pomar; Rafael Melgares; Fernando Rivero; Pilar Jiménez-Quevedo; Nieves Gonzalo; Cristina Fernández; Carlos Macaya Journal: J Am Coll Cardiol Date: 2015-07-07 Impact factor: 24.094
Authors: Yuan Fu; Yixing Yang; Chen Fang; Xinming Liu; Ying Dong; Li Xu; Mulei Chen; Kun Zuo; Lefeng Wang Journal: Front Cardiovasc Med Date: 2022-08-30