Author + information
- Received April 28, 2010
- Revision received June 25, 2010
- Accepted July 27, 2010
- Published online November 30, 2010.
- George D. Dangas, MD*,†,* (, )
- Bimmer E. Claessen, MD†,
- Adriano Caixeta, MD†,
- Elias A. Sanidas, MD†,
- Gary S. Mintz, MD† and
- Roxana Mehran, MD*,†
- ↵*Reprint requests and correspondence:
Dr. George D. Dangas, Cardiovascular Institute (Box 1030), Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York 10029
The introduction of the drug-eluting stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention. However, the rapid implementation of DES in standard practice and expansion of the indications for percutaneous coronary intervention to high-risk patients and complex lesions also introduced a new problem: DES in-stent restenosis (ISR), which occurs in 3% to 20% of patients, depending on patient and lesion characteristics and DES type. The clinical presentation of DES ISR is usually recurrent angina, but some patients present with acute coronary syndrome. Mechanisms of DES ISR can be biological, mechanical, and technical, and its pattern is predominantly focal. Intravascular imaging can assist in defining the mechanism and selecting treatment modalities. Based upon the current available evidence, an algorithm for the treatment approaches to DES restenosis is proposed.
Dr. Dangas is a consultant for and has received speaker honoraria from Cordis/Johnson & Johnson and Abbott Vascular. Dr. Mintz has received grant/consultant support from Volcano, and honoraria/grant support from Boston Scientific. Dr. Mehran s a consultant for and has received speaker honoraria from Cordis/Johnson & Johnsonand Abbott Vascular. All other authors have reported that they have no relationships to disclose.
- Received April 28, 2010.
- Revision received June 25, 2010.
- Accepted July 27, 2010.
- American College of Cardiology Foundation