Coronary In-Stent Restenosis: JACC State-of-the-Art Review

Gennaro Giustino, Antonio Colombo, Anton Camaj, Keisuke Yasumura, Roxana Mehran, Gregg W. Stone, Annapoorna Kini, Samin K. Sharma

Research output: Contribution to journalReview articlepeer-review

68 Scopus citations


The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.

Original languageEnglish
Pages (from-to)348-372
Number of pages25
JournalJournal of the American College of Cardiology
Issue number4
StatePublished - 26 Jul 2022


  • coronary artery disease
  • drug-eluting stent
  • in-stent restenosis
  • revascularization


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