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European Heart Journal 2003 24(2):138-150; doi:10.1016/S0195-668X(02)00418-9
Copyright © 2003 by the European Society of Cardiology.
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Review article

The challenge of in-stent restenosis: insights from intravascular ultrasound

V. Spanosa, G. Stankovica, J. Tobisb and A. Colomboa,*

a Centro Cuore Columbus and San Raffaele Hospital, Via M. Buonarroti 48, 20145 Milan, Italy
b Los Angeles Center for Health Sciences, University of California, Los Angeles, CA, USA

* Corresponding author

Key Words: In-stent restenosis • Intravascular ultrasound • Stent implantation • IVUS guidance • Brachytherapy • Drug-eluting stent

The first 150 words of the full text of this article appear below.

1. Introduction

The effectiveness of coronary stents in reducing angioplasty restenosis rates in de novo and restenotic lesions1–3 and their use without systemic anticoagulation4–6 prompted widespread acceptance of this technology. Despite these achievements, recurrence of luminal narrowing due to in-stent restenosis (ISR) occurs in a relatively high percentage of cases, when stents are implantedin complex lesions,7 long lesions,8,9 and smallvessels.10,11 The number of ISR cases is growing: from 100 000 patients treated worldwide in 1997 to an estimated 150 000 cases in 2001 in the USA alone.

The management of ISR has not been simple. Recurrent restenosis despite treatment is relatively high and can occur in up to 80% of cases, depending on clinical and angiographic characteristics.12,13 As a result, prevention and treatment of ISR has been a challenge for interventional cardiology. Intravascular ultrasound (IVUS) has played a pivotal role in defining the mechanisms of ISR and optimizing the treatment, due to . . . [Full Text of this Article]

2. IVUS during stent implantation

3. Mechanisms of in-stent restenosis: IVUS observations

4. Treatment of in-stent restenosis: IVUS insights

4.1. Balloon angioplasty
4.2. Cutting balloon angioplasty
4.3. Debulking techniques
4.4. Re-stenting
4.5. Brachytherapy
4.6. Drug-eluting stents
5. Conclusions


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