title: Treatment of in-stent restenosis.
abstract: 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.
authors.affiliation: Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, DC, USA. gsm1@mhg.edu
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: R
authors.initials: R
authors.lastname: Waksman
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: 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