In-Stent Restenosis in Drug-Eluting Stents: Issues and Therapeutic Approach

Implantation of coronary drug-eluting stent (DES) became a predominant therapeutic strategy for coronary artery disease. One of the possible complications after DES implantation is in-stent restenosis (ISR) and today it becomes a significant issue for interventional cardiologists that requires further sustained and efficacious treatment. Widely accepted classification of DES-ISR is morphological classification proposed by Mehran et al. Currently available and effective therapeutic approach for DES-ISR include conventional balloon angioplasty, cutting or scoring balloon angioplasty, drug-coated/drug-eluting balloon angioplasty (DCB/DEB), DES in DES stenting (same or different), vascular brachytherapy and coronary artery bypass grafting (CABG). However, optimal treatment for DES-ISR remains unknown. Bioresorbable vascular scaffolds (BVS) offer initial hope, but further clinical studies are required to establish their longterm efficacy and safety.