State-of-the-Art Paper
Current Treatment of In-Stent Restenosis

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Management of patients with in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (DES) have drastically reduced the incidence of ISR, treatment of DES-ISR is particularly challenging. ISR mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR and may be used to guide repeated interventions. In this paper, we systematically reviewed clinical trial data with currently available therapeutic modalities, including DES and drug-coated balloons, in patients presenting with ISR within bare-metal stents or DES.

Key Words

bare-metal stents
drug-coated balloons
drug-eluting stents
in-stent restenosis
intravascular ultrasound
neoatherosclerosis
optical coherence tomography

Abbreviations and Acronyms

BA
balloon angioplasty
BMS
bare-metal stent(s)
DCB
drug-coated balloon(s)
DES
drug-eluting stent(s)
ISR
in-stent restenosis
OCT
optical coherence tomography

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Dr. Byrne has received speaker's fees from B. Braun and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.