Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents

Difference of Tissue Characteristics Between Early and Late Restenosis After Second-Generation Drug-Eluting Stents Implantation ― An Optical Coherence Tomography Study ―

“…11 More recently, Goto et al reported from their IVUS study that both NIH and stent underexpansion emerged as the main causes of ISR even in the secondgeneration DES era. 25 However, there were a number of limitations to that study, such as very few cases of L-ISR after second-generation DES implantation and use of gray-scale IVUS. Considering those findings, the mechanism of ISR at the different phases after implanting second-generation DES with partial improvement of the problem, which first-generation DES had, has not yet been fully evaluated.…”

Optical Coherence Tomography Predictors for Recurrent Restenosis After Paclitaxel-Coated Balloon Angioplasty for Drug-Eluting Stent Restenosis

“…10, 11 Previous studies by intravascular ultrasound indicate that stent underexpansion and neointimal hyperplasia are the mechanisms responsible for ISR after DES implantation. 12, 13 However, there are currently inadequate data on intracoronary imaging during PCB angioplasty to evaluate the cause of recurrent restenosis after PCB angio-was advanced to the distal end of the stent through a 3-Fr occlusion balloon catheter. To remove blood from the field of view, the occlusion balloon was inflated up to 0.6 atm at a proximal site of the lesion, and warm Ringer's lactate solution was infused into the coronary artery from the distal tip of the occlusion balloon catheter at a rate of 0.7 mL/s.…”

Drug‐coated balloons for the treatment of in‐stent restenosis in diabetic patients: A review of currently available scientific data

“…Thanks to the widespread use of bare metal stents in the mid 90's, a consistent reduction of 20‐40% dependent upon the type of lesion and acuity in restenosis rate from the plain only balloon angioplasty era took place . The introduction of DES proved to be another important step forward in reducing the rates of restenosis, basically thanks to their effects on NIH . Since the beginning of his use, PES proved to be more effective than standard stenting in preventing ISR, reducing TLR, and thus, MACE rate as confirmed by the TAXUS IV trial, .…”

“…Negative remodeling is an active, profibrotic process mediated by myofibroblasts from the adventitia that shrinks after the exposure induced by the balloon‐induced injury . While elastic recoil and negative remodeling could be partially resolved by the radial force given by an implanted metallic structure, coronary stents per se do not have the capacity to contrast neointimal hyperplasia (NIH), . Mechanical injury of the arterial wall due to stretching during the inflation with a balloon catheter results in the recruitment of inflammatory cells such as monocytes, macrophages, and neutrophils to the site of injury, along with platelet aggregation, proliferation, and migration of vascular smooth muscle cells and deposition of collagen primarily in the tunica intima , all of these leading to the thickening of arterial walls with subsequent decreased arterial lumen space .…”