Related Experiment Video

Updated: Jun 6, 2026

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
04:30

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

In-stent restenosis in the drug-eluting stent era

George D Dangas1, Bimmer E Claessen, Adriano Caixeta

  • 1Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA. george.dangas@mssm.edu

Journal of the American College of Cardiology
|November 27, 2010
PubMed

Insights

Drug-eluting stents (DES) reduce restenosis but can cause in-stent restenosis (ISR). This review proposes an algorithm for managing DES ISR, a common complication, based on current evidence and intravascular imaging.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Drug-eluting stents (DES) significantly reduced restenosis and target lesion revascularization post-percutaneous coronary intervention.
  • Widespread DES adoption and expanded indications have led to the emergence of DES in-stent restenosis (ISR).
  • ISR affects 3-20% of patients, with presentation typically as recurrent angina or acute coronary syndrome.

Purpose of the Study:

  • To review the mechanisms and clinical presentation of DES ISR.
  • To highlight the role of intravascular imaging in diagnosing DES ISR.
  • To propose a treatment algorithm for DES ISR based on current evidence.

Main Methods:

  • Literature review of studies on DES ISR.
  • Analysis of mechanisms (biological, mechanical, technical) and patterns of DES ISR.
  • Evaluation of intravascular imaging modalities for ISR assessment.

Main Results:

  • DES ISR is a significant complication with diverse underlying mechanisms and a predominantly focal pattern.
  • Intravascular imaging is crucial for accurate diagnosis and mechanism identification.
  • An evidence-based algorithm for DES ISR treatment is proposed.

Conclusions:

  • DES ISR requires specific management strategies.
  • Intravascular imaging guides optimal treatment selection for DES ISR.
  • The proposed algorithm aims to standardize and improve DES ISR treatment outcomes.

More Related Videos

Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model09:46

Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model

Published on: September 14, 2009

Related Concept Videos

Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Angina II: Classification01:27

Angina II: Classification

Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...