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Updated: Jun 20, 2026
06:30
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Management of total restenotic occlusions
Gerald S Werner1, Hiller Moehlis, Karlheinz Tischer
1Medizinische Klinik (Cardiology & Intensive Care), Klinikum Darmstadt, Darmstadt, Germany. gerald.werner@klinikum-darmstadt.de
Summary
In-stent chronic re-occlusions (ISR-CTOs) present unique challenges for treatment success and recurrence prevention. Current data is limited, with lower success rates and higher recurrence compared to other lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- In-stent restenosis (ISR) poses challenges, with in-stent chronic re-occlusions (ISR-CTOs) being a particularly difficult subset.
- ISR-CTOs have unfavorable features impacting repeat procedure success and lesion recurrence prevention.
- These lesions are often excluded from major clinical trials, limiting evidence-based treatment strategies.
Purpose of the Study:
- To review the current literature and personal data on the prevalence and treatment outcomes of ISR-CTOs.
- To highlight the limited evidence and challenges associated with managing ISR-CTOs.
- To discuss the potential future impact of drug-eluting stents (DES) on ISR-CTO prevalence.
Main Methods:
- Literature review of ISR and ISR-CTO management.
- Analysis of personal databases and clinical experience with ISR-CTOs.
- Comparison of treatment outcomes for ISR-CTOs versus non-occlusive ISR and primary CTOs.
Main Results:
- ISR-CTOs represent 5-10% of chronic total occlusions (CTOs) with limited long-term treatment data.
- Brachytherapy for ISR-CTOs shows inferior outcomes compared to non-occlusive ISR.
- Drug-eluting stents (DES) show a primary success rate of ~70% for ISR-CTOs, with a 25% recurrence rate, lower than primary CTOs.
Conclusions:
- ISR-CTOs are a significant clinical problem lacking systematic investigation.
- Current treatment options for ISR-CTOs have suboptimal outcomes.
- Future widespread use of DES may reduce the incidence of diffuse and occlusive ISR, potentially decreasing the relevance of ISR-CTOs.
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