Recurrent Drug-Eluting Stent In-Stent Restenosis: A State-of-the-Art Review of Pathophysiology, Diagnosis, and Management

Achintya D Singh; Aayush K Singal; Agrima Mian; Samir R Kapadia; David P Hedrick; Anmar Kanaa'N; Jaikirshan J Khatri; Rishi Puri; Ankur Kalra

doi:10.1016/j.carrev.2020.01.005

Recurrent Drug-Eluting Stent In-Stent Restenosis: A State-of-the-Art Review of Pathophysiology, Diagnosis, and Management

Cardiovasc Revasc Med. 2020 Sep;21(9):1157-1163. doi: 10.1016/j.carrev.2020.01.005. Epub 2020 Jan 10.

Authors

Achintya D Singh¹, Aayush K Singal², Agrima Mian³, Samir R Kapadia⁴, David P Hedrick⁴, Anmar Kanaa'N⁴, Jaikirshan J Khatri⁴, Rishi Puri⁴, Ankur Kalra⁵

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America.
² Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
³ Oncology, Taussig Cancer Centre, Cleveland Clinic, Cleveland, OH, United States of America.
⁴ Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States of America.
⁵ Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States of America. Electronic address: [email protected].

PMID: 31959561
DOI: 10.1016/j.carrev.2020.01.005

Abstract

Recurrent in-stent restenosis (R-ISR) refers to the re-occlusion of a successfully treated in-stent restenosis. Much of the present understanding of this condition stems from studies on in-stent restenosis, as literature on R-ISR is sparse. Compounded by multiple previous struts, narrower luminal diameters and worse patient profiles, R-ISR is a clinical challenge that demands urgent attention. Recent studies have explored various diagnostic and therapeutic strategies to identify and suitably manage R-ISR. In this review, we discuss our understanding of the risk factors, invasive and non-invasive imaging techniques, therapeutic options and gaps in present knowledge for the management of R-ISR.

Keywords: In-stent restenosis (ISR); Recurrent in-stent restenosis (R-ISR).

Publication types

Review

MeSH terms

Coronary Angiography
Coronary Restenosis*
Drug-Eluting Stents*
Humans
Risk Factors
Stents
Treatment Outcome