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In-Stent Restenosis: Incidence, Mechanisms, and Treatment Options

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Abstract

Purpose of Review

To provide an overview of up-to-date treatment practices for in-stent restenosis (ISR).

Recent Findings

ISR is treated with similar effectiveness by paclitaxel drug coated balloons and second-generation drug eluting stents. Sirolimus coated balloons are an emerging technology that requires further investigation.

Summary

The management of ISR remains challenging even with the newest generation of drug-eluting stents. The use of intravascular imaging is highly recommended to identify the mechanisms of stent failure and to tailor the method of treatment, whether it is plain old balloon angioplasty, plaque/calcium modifying tools such as intravascular lithotripsy or rotational atherectomy, additional drug eluting stents, or drug coated balloons. Paclitaxel drug coated balloons are the most recent technological advancement which has provided an option to treat ISR that doesn’t require further layers of metal. Currently, other drug coatings are being studied but it is unclear whether these balloons are as effective as paclitaxel coated balloons, with ongoing trials designed to answer this question.
Title
In-Stent Restenosis: Incidence, Mechanisms, and Treatment Options
Authors
Michael Sola
Zachary Tugaoen
Jessica Willis
George A. Stouffer
Publication date
01-12-2025
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 1/2025
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-025-02249-0
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Independent Medical Education Grant:
  • Bayer HealthCare Pharmaceuticals Inc.
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Image Credits
Abstract graphic of layered, concentric circular shapes in bright green, pink, blue, and purple on a dark blue background. The rings and segments form a complex radial pattern without text/© Springer Health+ IME