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Review
. 2025 Jun 19;27(1):96.
doi: 10.1007/s11886-025-02249-0.

In-Stent Restenosis: Incidence, Mechanisms, and Treatment Options

Michael Sola  1 , Zachary Tugaoen  1 , Jessica Willis  1 , George A Stouffer  2   3
Affiliations
Review

In-Stent Restenosis: Incidence, Mechanisms, and Treatment Options

Michael Sola et al. Curr Cardiol Rep. .

Abstract

Purpose of review: To provide an overview of up-to-date treatment practices for in-stent restenosis (ISR).

Recent findings: ISR is treated with similar effectiveness by paclitaxel drug coated balloons and second-generation drug eluting stents. Sirolimus coated balloons are an emerging technology that requires further investigation. The management of ISR remains challenging even with the newest generation of drug-eluting stents. The use of intravascular imaging is highly recommended to identify the mechanisms of stent failure and to tailor the method of treatment, whether it is plain old balloon angioplasty, plaque/calcium modifying tools such as intravascular lithotripsy or rotational atherectomy, additional drug eluting stents, or drug coated balloons. Paclitaxel drug coated balloons are the most recent technological advancement which has provided an option to treat ISR that doesn't require further layers of metal. Currently, other drug coatings are being studied but it is unclear whether these balloons are as effective as paclitaxel coated balloons, with ongoing trials designed to answer this question.

Keywords: Drug Coated Balloons; Drug Eluting Stents; Brachytherapy; In-stent Restenosis; Intravascular Imaging; Target Lesion Revascularization.

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Conflict of interest statement

Declarations. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: The authors declare no competing interests. Conflict of Interest: The authors declare that they have no conflict of interest.

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