Chapter 21
In-Stent Restenosis in the New Generation DES Era
Marco G. Mennuni,
Emanuele Sagazio,
Giuseppe Patti,
Marco G. Mennuni
Search for more papers by this authorEmanuele Sagazio
Search for more papers by this authorGiuseppe Patti
Search for more papers by this authorMarco G. Mennuni,
Emanuele Sagazio,
Giuseppe Patti,
Marco G. Mennuni
Search for more papers by this authorEmanuele Sagazio
Search for more papers by this authorGiuseppe Patti
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorSummary
In-stent restenosis has been common after bare metal stent implantation and its classification is prognostically important. Drug eluting stents restenose less often; imaging can clarify the different mechanism operational in a particular case and allow development of a rational treatment plan. Neoatherosclerosis is a new mechanism for very late occurring stent restenosis. A new drug eluting stent is used in restenosis extending outside stent edges and after a partially successful results of other devices in different types of cases. Adding multiple layers of stents is generally undesirable; drug eluting balloons may offer a useful alternative. Atherectomy may be used to debulk extensive neointimal hyperplasia. Coronary bypass surgery is useful in recurrent restenosis and multivessel disease with good distal targets. Brachytherapy remains a palliative option.
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