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Intravascular Imaging for Guiding In-Stent Restenosis and Stent Thrombosis Therapy.

Abstract
Advances in stent technology and the design of endovascular devices with thinner struts, anti-inflammatory and antithrombotic polymers, and better drug kinetics have enhanced the safety and efficacy of the second-generation drug-eluting stents and broadened their use in the therapy of high-risk patients and complex anatomies. However, despite these developments, in-stent restenosis and stent thrombosis remain the Achilles' heel of percutaneous coronary intervention, with their cumulative incidence reaching up to 10% at 5 years following percutaneous coronary intervention. The treatment of stent failure poses challenges and is associated with a worse prognosis than conventional percutaneous coronary intervention. Several studies have recently highlighted the value of intravascular imaging in identifying causes of stent failure, underscored its role in treatment planning, and registries have shown that its use may be associated with better clinical outcomes. The present review aims to summarize the evidence in the field; it discusses the value of intravascular imaging in identifying the mechanisms of in-stent restenosis and stent thrombosis in assessing the morphological characteristics of neointima tissue that appears to determine long-term outcomes in evaluating procedural results, and presents the findings of studies supporting its value in guiding therapy in stent failure.
AuthorsEmrah Erdogan, Retesh Bajaj, Alexandra Lansky, Anthony Mathur, Andreas Baumbach, Christos V Bourantas
JournalJournal of the American Heart Association (J Am Heart Assoc) Vol. 11 Issue 22 Pg. e026492 (11 15 2022) ISSN: 2047-9980 [Electronic] England
PMID36326067 (Publication Type: Journal Article, Review, Research Support, Non-U.S. Gov't)
Topics
  • Humans
  • Coronary Restenosis (diagnostic imaging, etiology, therapy)
  • Coronary Vessels
  • Prosthesis Design
  • Percutaneous Coronary Intervention (adverse effects)
  • Stents (adverse effects)
  • Thrombosis (diagnostic imaging, etiology, therapy)
  • Tomography, Optical Coherence
  • Treatment Outcome

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