Interv Akut Kardiol. 2023;22(3):122-128 | DOI: 10.36290/kar.2022.032

Treatment options of in­‑stent restenosis: mini review

Rana Zhafira Amanda¹, Natasha Anindhia Harsas², Sidhi Laksono Purwowiyoto^{3, 4}

¹ Department of Emergency Medicine, Urip Sumoharjo Hospital, Bandar Lampung, Indonesia

² Department of Emergency Medicine, Pertamina Central Hospital, Jakarta, Indonesia

³ Department of Cardiology and Vascular Medicine, Pertamina Central Hospital, Jakarta, Indonesia

⁴ Faculty of Medicine, Universitas Muhammadiyah Prof Dr Hamka, Tangerang, Indonesia

In­‑stent restenosis (ISR) is the leading cause of the need for reintervention after percutaneous coronary intervention (PCI). Lumen diameter reduction may occur due to early elastic return, vascular remodelling, or aggressive neointimal hyperplasia in the luminal surface of the stent. Recent data also suggest that a newly occurring atherosclerotic process called „neoatherosclerosis“ can play an essential role in the development of ISR. Numerous studies have shown a high incidence of acute coronary syndrome (ACS) as a clinical manifestation of ISR and its association with increased mortality and morbidity. Stent improvements, novel drug regimens, and technological advances have expanded the scope of treatment for ISR. Intracoronary imaging is also beneficial in guiding the intervention. The development of DES has been shown to reduce the incidence of ISR. However, target lesion revascularisation still exists and may occur within 5 years and 10 years (in 10% and 20%, respectively). Thus, it is necessary to consider the strategy to prevent and manage ISR optimally in order to avoid the possibility of another episode of restenosis. In this paper, we systematically reviewed ISR and its various treatments based on recent literature reviews.

Keywords: ISR, definition, incidence, classification, mechanism, clinical presentation, management

Received: August 8, 2022; Revised: November 23, 2022; Accepted: November 28, 2022; Published: November 7, 2023  Show citation