Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9(8): 640-651 [PMID: 28932353 DOI: 10.4330/wjc.v9.i8.640]
Corresponding Author of This Article
M Chadi Alraies, MD, Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States. alraies@hotmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Aug 26, 2017; 9(8): 640-651 Published online Aug 26, 2017. doi: 10.4330/wjc.v9.i8.640
Diagnosis and management challenges of in-stent restenosis in coronary arteries
M Chadi Alraies, Fahed Darmoch, Ramyashree Tummala, Ron Waksman
M Chadi Alraies, Ron Waksman, Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
Fahed Darmoch, Ramyashree Tummala, Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
Author contributions: Alraies MC prepared the outline reviewed the literature and contributed with more than 80% to the manuscript write up; Darmoch F reviewed pathogenesis, incidence and management sections and contributed with the table and imaging; Tummala R wrote the pathogenesis, incidence and edited management sections; and Waksman R review the whole manuscript, made critical changes according to the reviewers’ comments.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: M Chadi Alraies, MD, Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States. alraies@hotmail.com
Telephone: +1-216-2550008
Received: December 5, 2016 Peer-review started: December 5, 2016 First decision: December 19, 2016 Revised: May 27, 2017 Accepted: July 14, 2017 Article in press: July 17, 2017 Published online: August 26, 2017 Processing time: 263 Days and 7.9 Hours
Abstract
Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. Due to these favorable findings, DES was rapidly and widely adopted enabling more complex coronary interventions. Nevertheless, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists.
Core tip: Percutaneous coronary intervention with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. However, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists. This review focuses on pathogenesis, diagnosis and treatment options for ISR in the current era of advanced intravascular imaging and intervention.
