Beyond Angiography: Integrating Advanced Diagnostic Modalities in Coronary Stent Restenosis-a Systematic Review

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• In-stent restenosis (ISR) poses a significant challenge post-percutaneous coronary intervention (PCI), impacting patient care.
• Current diagnostic and management strategies require comprehensive review to address this issue.

Purpose of the Study:

• To provide a thorough examination of current in-stent restenosis diagnostic methods.
• To offer holistic recommendations for ISR management, from prevention to treatment.

Main Methods:

• Review of anatomical assessment tools: coronary angiography (CAG), intravascular ultrasound (IVUS), optical coherence tomography (OCT).
• Review of functional assessment tools: fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), CT-derived Fractional Flow Reserve (CT-FFR), quantitative flow ratio (QFR).
• Exploration of advanced technologies: multimodal imaging fusion, artificial intelligence (AI), biomarkers, and genomics.

Main Results:

• Anatomical and functional assessments, enhanced by high-resolution imaging and flow quantification, are crucial for ISR detection and optimization.
• Non-invasive techniques and AI integration are transforming diagnostic accuracy and efficiency.
• Biomarkers and genomics offer valuable insights into ISR risk assessment.

Conclusions:

• Integrated anatomical-functional-molecular assessments represent the future of ISR diagnosis.
• AI-driven personalized management strategies are key to refining ISR care and improving patient prognosis.