In-stent restenosis in the drug-eluting stent era

George D. Dangas, Bimmer E. Claessen, Adriano Caixeta, Elias A. Sanidas, Gary S. Mintz, Roxana Mehran

Research output: Contribution to journalReview articlepeer-review

637 Scopus citations


The introduction of the drug-eluting stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention. However, the rapid implementation of DES in standard practice and expansion of the indications for percutaneous coronary intervention to high-risk patients and complex lesions also introduced a new problem: DES in-stent restenosis (ISR), which occurs in 3% to 20% of patients, depending on patient and lesion characteristics and DES type. The clinical presentation of DES ISR is usually recurrent angina, but some patients present with acute coronary syndrome. Mechanisms of DES ISR can be biological, mechanical, and technical, and its pattern is predominantly focal. Intravascular imaging can assist in defining the mechanism and selecting treatment modalities. Based upon the current available evidence, an algorithm for the treatment approaches to DES restenosis is proposed.

Original languageEnglish
Pages (from-to)1897-1907
Number of pages11
JournalJournal of the American College of Cardiology
Issue number23
StatePublished - 30 Nov 2010


  • Drug-eluting stent(s)
  • In-stent restenosis
  • Target lesion revascularization


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