Evaluation and management of drug-eluting stent in-stent restenosis

Abstract

Purpose of review In-stent restenosis (ISR) is the most common cause of stent failure. Although the rate of ISR is significantly lower with contemporary drug-eluting stents (DES), it remains a challenging clinical entity to treat. Recent findings In this review, we focus on a practical approach to management of DES ISR with intravascular imaging at its core, as supported by several recently published articles. This facilitates assessment of the underlying mechanism(s) essential to the successful treatment of ISR allowing for a tailored selection of treatment modalities. Summary The successful treatment of DES ISR requires identification of the causative mechanism(s). Individualized treatment may include high-pressure balloon angioplasty alone, cutting or scoring balloons, intravascular lithotripsy, atheroablative therapies and a selection of either repeat DES implantation or drug-coated balloon treatment.

The Best Strategy for the Black Hole Phenomenon between Intravascular Ultrasound and Optical Coherence Tomography

“…In recent years, the use of drug-eluting stents (DESs) has reduced ISR and major adverse cardiac events [3,4]. However, ISR after DES implantation still occurs [5,6]. The black hole (BH) phenomenon is when an intraluminal restenotic lesion image is obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) [7][8][9][10][11][12].…”

“…Following the placement of a coronary stent, ISR can commonly emerge as a complication [1,2]. Despite advances in technology, the occurrence rate of ISR has remained relatively consistent, affecting approximately 10% of patients after DES implantation [5,6].…”