Diagnosis and management challenges of in-stent restenosis in coronary arteries

doi:10.4330/wjc.v9.i8.640

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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.

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.

Keywords: Stent; In-stent; Restenosis; Percutaneous coronary intervention

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.