Treatment of coronary artery in-stent restenosis

Damianos G. Kokkinidis, Stephen W. Waldo, Ehrin J. Armstrong

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Introduction: Although drug-eluting stents (DES) have significantly reduced the incidence and prevalence of coronary in-stent restenosis (ISR), ISR still occurs in approximately 10% of patients in real-world practice. Areas covered: The development of newer generations of DES, drug-coated balloons (DCB) and increased use of intracoronary imaging have improved our treatment options for and pathophysiologic understanding of ISR. These technological advancements have also largely supplanted older modalities for treatment of ISR, such as brachytherapy, bare metal stents, conventional and cutting balloon angioplasty, and atherectomy devices. This article reviews the presentation, pathophysiology, and treatment of coronary artery ISR, with a focus on recent clinical data and emerging therapies for this difficult to treat clinical problem. Expert commentary: DCB and second-generation DES are the most effective treatment options for ISR. Most trials support a slight superiority of second-generation DES, while DCB have the advantage of not adding another metal layer. The role of bioresorbable vascular scaffolds will be determined in the near future.

Original languageEnglish (US)
Pages (from-to)191-202
Number of pages12
JournalExpert Review of Cardiovascular Therapy
Issue number3
StatePublished - Mar 4 2017
Externally publishedYes


  • Coronary artery disease
  • drug-coated balloons
  • drug-eluting stents
  • in-stent restenosis
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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