Stent failure: the diagnosis and management of intracoronary stent restenosis

ABSTRACT

Introduction

Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifested as intracoronary stent restenosis (ISR). Even with advances in stent technology and medical therapy, this complication is reported to affect around 10% of all percutaneous coronary intervention (PCI) procedures. Depending on stent type (drug-eluting versus bare metal), ISR has subtle differences in mechanism and timing and offers different challenges in diagnosing etiology and subsequent treatment options.

Areas covered

This review will be visiting the definition, pathophysiology, and risk factors of ISR.

Expert opinion

The evidence behind management options has been illustrated with the aid of real life clinical cases and summarized in a proposed management algorithm.

KEYWORDS:

• coronary artery disease
• in-stent restenosis
• intracoronary stent restenosis
• ischemic heart disease
• percutaneous coronary intervention

Article highlights

• The incidence of ISR varies by stent type and definition but is reported to affect 2–20% of all PCI at 5 years.

• Factors influencing the development of ISR include pharmacology, biology, patient risk factors, lesion characteristics, or mechanical variables relating to stent implantation

• The mainstay of diagnosis of ISR is coronary angiography with the aid of intracoronary imaging

• The management of ISR varies depending on the etiology as often determined by intracoronary imaging.

• Once the etiology is defined, treatment can be in the form of new stent implantation (third generation drug-eluting stent) or drug-coated balloon (DCB) treatment. An algorithm is presented in this article with example case studies (in Supplementary Reading).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2221852

Additional information

Funding

This paper was not funded.