@article{3c2f580d53ee4f49a46ec584a9f3b8d7,
title = "Coronary In-Stent Restenosis: JACC State-of-the-Art Review",
abstract = "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.",
keywords = "coronary artery disease, drug-eluting stent, in-stent restenosis, revascularization",
author = "Gennaro Giustino and Antonio Colombo and Anton Camaj and Keisuke Yasumura and Roxana Mehran and Stone, {Gregg W.} and Annapoorna Kini and Sharma, {Samin K.}",
note = "Funding Information: Stent gap can be defined as a discontinuous coverage of a coronary lesions between 2 stents and has been associated with higher risk of ISR and need for repeated revascularization.24 A gap between 2 DES leaves a zone of the coronary lesion not exposed to the antiproliferative effects of the released drug and the mechanical support of the metallic strut. PCI of coronary bifurcations is also associated with higher rates of restenosis and TLR compared with nonbifurcation lesions, and the implemented stenting technique can substantially influence clinical outcomes. Most noncomplex bifurcation lesions can be treated with the use of a 1-stent provisional approach.27 Conversely, in true left main bifurcation lesions (Medina 1,1,1 or 0,1,1), PCI using 2 stents with a double-kissing crush technique resulted in larger side-branch luminal diameter and lower rates of TLR compared with a provisional approach.28 When performing bifurcation stenting with a 2-stent technique, the implementation of poststenting optimization strategies, such as the proximal optimization technique (POT) or final kissing balloon dilatation, is essential to improve final stent geometry and vessel wall apposition, as well as long-term stent patency.27 Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",
year = "2022",
month = jul,
day = "26",
doi = "10.1016/j.jacc.2022.05.017",
language = "English",
volume = "80",
pages = "348--372",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "4",
}