Current Management of In-Stent Restenosis
www.mdpi.com
April 22, 2024, 12:01 p.m.
Despite substantial advances in stent technology, ISR remains the primary cause of target lesion failure after PCI. The available evidence supports the use of DCB angioplasty and DES implantation as first-line therapies for ISR. Nonetheless, the choice between DES and DCB should be individualized based on clinical, anatomical, and technical factors. In this regard, intravascular imaging with IVUS and OCT can be useful for identifying the primary mechanisms leading to ISR and guiding the interventional strategy during PCI. Moreover, emerging combined approaches employing lesion modification with cutting/scoring balloons, intravascular lithotripsy, rotational atherectomy, or excimer laser in association with DCB or DES can be advantageous in the treatment of specific patterns of ISR. Further high-quality data are needed to define the differential effectiveness and safety of contemporary DCBs and DESs, the long-term clinical outcomes, and whether there are preferential clinical and anatomic conditions for the use of one device over the other.