Morphologic patterns of in-stent restenosis

Gennaro Giustino, Daniele Giacoppo, Jennifer Yu, Roxana Mehran

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


In-stent restenosis (ISR), first described as a major limitation of percutaneous coronary intervention with bare-metal stents (BMS), continues to occur albeit at a reduced rate after the introduction of drug-eluting stents (DES). The pathogenesis of ISR is multifactorial and involves clinical, biological, mechanical and technical factors. Specific underlying mechanisms of ISR can often manifest in its morphological pattern and this has led to attempts in ISR morphology classification. In turn, the ISR pattern classification has been demonstrated to correlate with mid- and long-term outcomes following treatment. The predominant observed pattern of ISR differs between BMS and DES and reflects differences in the causative mechanisms of BMS- and DES- ISR. The most common ISR pattern in BMS is diffuse. Conversely the most common ISR pattern in DES is focal, with a higher prevalence of diffuse ISR associated with paclitaxel-eluting stents (PES) as compared to sirolimus-eluting stents (SES). In the DES era, the morphologic pattern of DES-ISR remains an important predictor of clinical outcomes. Finally, recent advances in intravascular imaging technology such as intravascular ultrasound virtual histology and optical coherence tomography have improved our understanding of the pathophysiology and morphologic patterns of ISR.

Original languageEnglish
Title of host publicationCoronary Artery Restenosis
Subtitle of host publicationCauses, Treatment and Clinical Outcomes
PublisherNova Science Publishers, Inc.
Number of pages35
ISBN (Electronic)9781633213531
ISBN (Print)9781633213463
StatePublished - 1 Jan 2014


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