From Mechanisms to Management: Tackling In-Stent Restenosis in the Drug-Eluting Stent Era.

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Cardiology Reports Pub Date : 2025-02-11 DOI:10.1007/s11886-025-02193-z

Luigi Spadafora, Rossella Quarta, Giovanni Martino, Letizia Romano, Francesco Greco, Antonio Curcio, Tommaso Gori, Carmen Spaccarotella, Ciro Indolfi, Alberto Polimeni

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Abstract

Purpose of review: Drug-eluting stent (DES) technology has greatly enhanced the safety and effectiveness of percutaneous coronary interventions (PCI). The aim of the present paper is to provide a comprehensive review of in-stent restenosis (ISR), focusing on the contemporary DES era, including its incidence, mechanisms, and imaging characterization.

Recent findings: Despite the widespread use of DES and numerous improvements, recent clinical data indicate that ISR still occurs in 5-10% of PCI procedures, posing a considerable public health issue. The incidence, morphology, and clinical implications of ISR are determined by a complex interplay of several factors: the patient, stent, procedure, and vessel and lesion-related factors. Advancements in intracoronary imaging have provided greater insight into its patterns and underlying causes. Over time, treatment strategies have evolved, and current guidelines recommend an individualized approach using intracoronary imaging to characterize ISR's underlying substrate.

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从机制到管理：处理药物洗脱支架时代的支架内再狭窄。

综述目的：药物洗脱支架（DES）技术大大提高了经皮冠状动脉介入治疗（PCI）的安全性和有效性。本文的目的是提供支架内再狭窄（ISR）的全面回顾，重点是当代DES时代，包括其发病率，机制和影像学表征。最近的研究结果：尽管DES的广泛使用和许多改进，最近的临床数据表明，仍有5-10%的PCI手术发生ISR，造成了相当大的公共卫生问题。ISR的发生率、形态和临床意义是由几个因素复杂的相互作用决定的：患者、支架、手术、血管和病变相关因素。冠状动脉内成像技术的进步为其模式和潜在原因提供了更深入的了解。随着时间的推移，治疗策略发生了变化，目前的指南推荐使用冠状动脉内成像的个体化方法来表征ISR的潜在基质。

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来源期刊

Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

6.20

自引率

2.70%

发文量

209

期刊介绍： The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.