Treatment of In-stent Restenosis – Past, Present and Future

In-stent restenosis (ISR) remains a significant clinical problem. The penetration of drug-eluting stents (DES) is quite variable and patients with DES may also suffer from ISR. Treatment of ISR remains a technical challenge and the long-term clinical outcome of these patients may be complicated by recurrences. Different strategies have been used for the treatment of patients with bare-metal ISR. Currently, DES constitute the intervention of choice in this setting. However, the best intervention for patients suffering from ISR after DES implantation remains to be elucidated. This report summarises our clinical and research efforts in this adverse anatomical scenario over the last decade. We will address the treatment of patients with ISR, revisiting the historical background, emphasising the currently available alternatives and disclosing future perspectives.

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Drug eluting stents for the treatment of bare metal in-stent restenosis: long-term outcomes in real world practice

EuroIntervention ◽

10.4244/eijv6i6a127 ◽

2011 ◽

Vol 6 (6) ◽

pp. 748-753 ◽

Cited By ~ 3

Author(s):

Clare Appleby ◽

Raj Khattar ◽

Kenneth Morgan ◽

Bernard Clarke ◽

Nicholas Curzen ◽

...

Keyword(s):

Real World ◽

Drug Eluting Stents ◽

Bare Metal ◽

Long Term Outcomes ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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LONG-TERM IN-STENT RESTENOSIS DEVELOPMENT IN CORONARY ARTERIES AFTER PERCUTANEOUS CORONARY INTERVENTIONS WITH BARE METAL AND DRUG-ELUTING STENTS IMPLANTATION DEPENDING ON CLINICAL DATA AND RISK FACTORS

Современные проблемы науки и образования (Modern Problems of Science and Education) ◽

10.17513/spno.26645 ◽

2017 ◽

Author(s):

V.P. Mazaev ◽

A.A. Komkov ◽

S.V. Ryazanova

Keyword(s):

Risk Factors ◽

Coronary Arteries ◽

Drug Eluting Stents ◽

Percutaneous Coronary Interventions ◽

Bare Metal ◽

Stent Restenosis ◽

Percutaneous Coronary ◽

Drug Eluting ◽

In Stent Restenosis

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P6115Difference of neoatherosclerosis pattern in lesions with in-stent restenosis among bare-metal, first and second generation drug-eluting stents: optical coherence tomography study

European Heart Journal ◽

10.1093/eurheartj/ehx493.p6115 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

D. Nakamura ◽

M. Nishino ◽

M. Yasunaga ◽

K. Yanagawa ◽

H. Nakamura ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Second Generation ◽

Drug Eluting Stents ◽

Bare Metal ◽

Optical Coherence ◽

Stent Restenosis ◽

Drug Eluting ◽

First And Second Generation ◽

In Stent Restenosis

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Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2020/8179849 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Yi-Xing Yang ◽

Yin Liu ◽

Chang-Ping Li ◽

Peng-Ju Lu ◽

Jiao Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Cochrane Library ◽

Bare Metal ◽

Stent Restenosis ◽

Positive Prevention ◽

Drug Eluting ◽

Drug Eluting Balloon ◽

In Stent Restenosis

Background. Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P<0.00001), TVR (P<0.00001), CD (P=0.02), ST/RE-ISR (P<0.00001), and MACEs (P<0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions. Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.

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CLINICAL PRESENTATION OF IN-STENT RESTENOSIS AND ANGIOGRAPHIC CONFIRMED STENT THROMBOSIS IN PATIENTS TREATED WITH BARE METAL OR DRUG-ELUTING STENTS. FROM WESTERN DENMARK HEART REGISTRY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61833-5 ◽

2010 ◽

Vol 55 (10) ◽

pp. A195.E1832

Author(s):

Per Thayssen ◽

Lisette Okkels Jensen ◽

Anne Kaltoft ◽

Hans Henrik Tilsted ◽

Michael Maeng ◽

...

Keyword(s):

Stent Thrombosis ◽

Clinical Presentation ◽

Drug Eluting Stents ◽

Bare Metal ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Vascular brachytherapy versus drug-eluting stents in the treatment of in-stent restenosis: A meta-analysis of long-term outcomes

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.25998 ◽

2015 ◽

Vol 87 (2) ◽

pp. 200-208 ◽

Cited By ~ 2

Author(s):

Alexandre Benjo ◽

Rhanderson N. Cardoso ◽

Tyrone Collins ◽

Daniel Garcia ◽

Francisco Y. Macedo ◽

...

Keyword(s):

Meta Analysis ◽

Drug Eluting Stents ◽

Long Term Outcomes ◽

Stent Restenosis ◽

Vascular Brachytherapy ◽

Drug Eluting ◽

In Stent Restenosis

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Femtosecond Laser Nanotexturing of Drug-Eluting Stents

Journal of Manufacturing Science and Engineering ◽

10.1115/1.4007713 ◽

2012 ◽

Vol 134 (6) ◽

Cited By ~ 5

Author(s):

Rajeev Nair ◽

Vaelan Molian ◽

Pal Molian

Keyword(s):

Femtosecond Laser ◽

Cost Effective ◽

Interventional Cardiology ◽

Drug Eluting Stents ◽

Potential Cost ◽

Polymer Carrier ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

Drug-eluting stents (DES) have profoundly affected the field of interventional cardiology by dramatically reducing the problem of in-stent restenosis. However, the adverse, long-term, thrombosis raises the questions on the safety profile of DES. Femtosecond pulsed laser nanotexturing of metallic stents was performed to minimize thrombosis by improving three fundamental characteristics of DES: (1) increase the availability of drug for elution; (2) enhance the adhesion between stent and drug; and (3) minimize and, if possible, eliminate the polymer carrier. Results of laser-induced nanoprotrusion/drug interactions confirmed these benefits and indicated that femtosecond laser nanotexturing is a potential cost-effective solution for improving the performance and safety of DES while eliminating the need for postfinishing operations.

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