• Fernandez, R.
• Kawakami, R.
• Mori, M.
• Cornelissen, A.
• Kawai, Kenji
• Guo, Liang
• Finn, Aloke
• Virmani, Renu
• Gadhoke, N.
• Me, Romero
• Fd, Kolodgie
• Fuller, D.

Abstract

<b>Introduction</b>: In-stent restenosis (ISR) has been one of the biggest limitations to the success of percutaneous coronary intervention for the treatment of coronary artery disease (CAD). The introduction of drug-eluting stent (DES) was a revolution in the treatment of CAD because these devices drastically reduced ISR to very low levels (<5%). Subsequently, newer generation DES treatments have overcome the drawbacks of first-generation DES, i.e. delayed endothelialization, and late stent thrombosis. However, the issue of late ISR, including neoatherosclerosis after DES implantation especially in high-risk patients and complex lesions, still exists as a challenge to be overcome.<b>Areas covered</b>: We discuss the mechanisms of ISR development including neoatherosclerosis, past and current clinical status of ISR, and methods to predict and overcome this issue from pathological and clinical points of view.<b>Expert opinion</b>: The initial drawbacks of first-generation DES, such as delayed endothelial healing and subsequent risk of late stent thrombosis, have been improved upon by the current generation DES. To achieve better long-term clinical outcomes, further titration of drug-release and polymer degradation profile, strut thickness as well as material innovation are needed.

Topics

• polymer
• collision-induced dissociation
• titration