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Review
. 2022 Jul 26;80(4):348-372.
doi: 10.1016/j.jacc.2022.05.017.

Coronary In-Stent Restenosis: JACC State-of-the-Art Review

Gennaro Giustino  1 , Antonio Colombo  2 , Anton Camaj  1 , Keisuke Yasumura  1 , Roxana Mehran  1 , Gregg W Stone  1 , Annapoorna Kini  1 , Samin K Sharma  3
Affiliations
Free article
Review

Coronary In-Stent Restenosis: JACC State-of-the-Art Review

Gennaro Giustino et al. J Am Coll Cardiol. .
Free article

Abstract

The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.

Keywords: coronary artery disease; drug-eluting stent; in-stent restenosis; revascularization.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Giustino has received advisory board fees from Bristol Myers Squibb/Pfizer. Dr Mehran has received institutional research payments from Abbott, Abiomed, Alleviant Medical, AM-Pharma, Applied Therapeutics, Arena, AstraZeneca, BAIM, Bayer, Beth Israel Deaconess, Biosensors, Biotronik, Boston Scientific, Bristol Myers Squibb, CardiaWave, CellAegis, CeloNova, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Duke University, Element Science, Humacyte, Insel Gruppe, Janssen, Magenta, Medtronic, Novartis, OrbusNeich, Philips, Vivasure, and Zoll, Dr Stone has received speaker and other honoraria from Cook, Terumo, Orchestra Biomed, and Qool Therapeutics; has served as a consultant to TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-Wave, Abiomed, Shockwave, MAIA Pharmaceuticals, Cardiomech, SpectraWave, Valfix, Ancora, and Vectorious; and owns equity/options in Applied Therapeutics, Biostar family of funds, MedFocus family of funds, Aria, Cardiac Success, Cagent, SpectraWave, Valfix, Ancora, Orchestra Biomed, and Qool Therapeutics. Dr Sharma has received honoraria as a Speakers Bureau member from Abbott Vascular, Boston Scientific, and Cardiovascular Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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