Treatment of in-stent restenosis.
Although in-stent restenosis is the result of neointimal hyperplasia, mechanical problems (e.g. stent underexpansion) that occurred during implantation may result in restenosis at follow-up. The treatment of in-stent restenosis, begins with identification of these occult mechanical problems. Thereafter, in-stent restenosis can be treated with PTCA, atheroablation, or additional stent implantation; it is nuclear which technique is superior. Not all in-stent restenosis lesions have a similar risk of recurrence. Recurrence appears to depend on several markers of biologic activity: focal vs diffuse in-stent restenosis, the first episode vs recurrent in-stent restenosis, and early vs late recurrence. Vascular brachytherapy has emerged as the most promising way to treat high-risk lesion subsets.
Mintz
G S
GS
Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, DC, USA. gsm1@mhg.edu
Mehran
R
R
Waksman
R
R
Pichard
A D
AD
Kent
K M
KM
Satler
L F
LF
Leon
M B
MB
D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D001918:Brachytherapy; D017115:Catheter Ablation; D003328:Coronary Thrombosis / Q000628:therapy*; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D015607:Stents