MedStar Authors catalog › Details for: Restenosis of Drug-Eluting Stents: A New Classification System Based on Disease Mechanism to Guide Treatment and State-of-the-Art Review. [Review]
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Restenosis of Drug-Eluting Stents: A New Classification System Based on Disease Mechanism to Guide Treatment and State-of-the-Art Review. [Review]

by Iantorno, Micaela; Shlofmitz, Evan; Waksman, Ron.
Citation: ; Circulation: Cardiovascular Interventions. 12(8):e007023, 2019 08..Journal: Circulation. Cardiovascular interventions.Published: ; 2019; ISSN: 1941-7640.Full author list: Iantorno M; Shlofmitz E; Waksman R.UI/PMID: 31345066.Subject(s): Clinical Decision-Making | Treatment Outcome | Risk Factors | Retreatment | Prosthesis Design | *Percutaneous Coronary Intervention/is [Instrumentation] | *Percutaneous Coronary Intervention/ae [Adverse Effects] | Patient Selection | Incidence | Humans | *Drug-Eluting Stents | Decision Support Techniques | *Coronary Restenosis/th [Therapy] | Coronary Restenosis/ep [Epidemiology] | Coronary Restenosis/dg [Diagnostic Imaging] | *Coronary Artery Disease/th [Therapy] | Coronary Artery Disease/dg [Diagnostic Imaging]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1161/CIRCINTERVENTIONS.118.007023 (Click here) Abbreviated citation: ; Circ., Cardiovasc. interv.. 12(8):e007023, 2019 08.Local Holdings: Available online from MWHC library: 2008 - present.Abstract: Despite on-going evolution and iteration of drug-eluting stent (DES) technology, the prevalence of in-stent restenosis (ISR) remains relatively unchanged, encompassing =10% of percutaneous coronary interventions. The mechanism of ISR is multifactorial, including biological, mechanical, patient, and operator-related factors. The main mechanical contributors are stent underexpansion or fracture, while biological factors include local inflammation leading to aggressive neointimal proliferation and late neoatherosclerosis. Intracoronary imaging is critical to identify the mechanism of ISR and tailor therapy accordingly. The presentation of DES-ISR is not benign and is challenging for optimal treatment. Among the proposed treatment modalities are scoring and high-pressure balloons, percutaneous coronary intervention with additional DES, atheroablative therapies by laser or mechanical atherectomy, drug-coated balloons, vascular brachytherapy, and surgical revascularization. We propose a new classification for ISR that differentiates among mechanical, biological, and mixed etiologies. Stratifying ISR by mechanism guides individualized treatment of DES-ISR to improve clinical outcomes. An algorithmic approach, guided by intracoronary imaging, for the treatment of DES-ISR, is recommended based on the specific cause of restenosis.

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