Instent Restenosis After PCI

Instent restenosis after PCI

Instent restenosis is often asymptomatic. One third of cases of instent restenosis can present with acute coronary syndrome and is sometimes quoted as an indication for coronary angiography at 3 to 6 months after unprotected left main stenting.

Neointimal proliferation in the form of excessive proliferation of tissue on the luminal surface of the stent contributes to in stent restenosis. Newly occurring atherosclerosis in the region is known as neoatherosclerosis [1].

In stent restenosis can be associated with recurrence of angina, though not always or an acute coronary syndrome. These may require either repeat PCI or even coronary artery bypass surgery. The re-intervention is known as target lesion revascularization or TLR [2]. The exact substrate of instent restenosis can be elucidated by intracoronary imaging modalities like intravascular ultrasound or optical coherence tomography, which can guide a repeat coronary intervention.

It may be noted that neointimal proliferation is much lesser with drug eluting stents compared to bare metal stents.

References

1. Dario Buccheri, Davide Piraino, Giuseppe Andolina, Bernardo Cortese. Understanding and Managing In-Stent Restenosis: A Review of Clinical Data, From Pathogenesis to Treatment. J Thorac Dis. 2016 Oct;8(10):E1150-E1162.
2. Fernando Alfonso, Robert A Byrne, Fernando Rivero, Adnan Kastrati. Current Treatment of In-Stent Restenosis. J Am Coll Cardiol. 2014 Jun 24;63(24):2659-73.