[Treatment of intrastent restenosis]

The use of stents has significantly reduced post PTCA restenosis rates. However, even with optimal stenting the rate of instant restenosis (ISR) is 8-15%. Thus, the extended use of stents (> or = 85% of angioplasty procedures) has made ISR a growing problem. We review the current interventional approach for treating ISR, where the strategy is dictated by the extent of the restenotic plaque. For focal lesions, redilation with balloon is the therapy of choice. For diffuse lesions, the Cutting Balloon offers good angiographic results with acceptable recurrence rates; in some selected cases, plaque removal can be helpful with a tendency for better results with rotablation. In centers where brachitherapy is available, this is considered the preferred approach for diffuse ISR. In all ISR cases, the alternatives of continuing medical therapy or surgical therapy should also be considered in the decision-making process.