title: Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment.
abstract: The lumen diameter reduction after percutaneous coronary intervention (PCI) is well known as "restenosis". This phenomenon is due to vessel remodeling/recoil in case of no-stent strategy or, in case of stent employ, "neointimal proliferation" that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a further new-occurring atherosclerotic process called "neoatherosclerosis". The exact incidence of in-stent restenosis (ISR) is not easy to determine caused by different clinical, angiographic and operative factors. In the pre-stent era the occurrence of restenosis ranged between 32-55% of all angioplasties, and drop to successively 17-41% in the bare metal stents (BMS) era. The advent of drug-eluting stent (DES), especially 2nd generation, and drug-coated balloon (DCB) further reduce restenosis rate until <10%. We here review the main characteristics of this common complication of coronary interventions, from its pathogenesis to the most appropriate treatment strategy.
authors.affiliation: Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Cardiology Department, San Giacomo D'Altopasso Hospital, Licata (Agrigento), Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Buccheri
authors.affiliation: Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Piraino
authors.affiliation: Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andolina
authors.affiliation: Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
keywords: In-stent restenosis (ISR); bare metal stents (BMS); drug-coated balloon (DCB); drug-eluting stent (DES); paclitaxel-eluting balloon (PEB); stent thrombosis (ST)