In-Stent Restenosis

Restenosis and In-stent restenosis (ISR) have been the “enemy” for interventional cardiologists for the past 40 years and many of the technical improvements in the last 20 years were aimed at reducing its occurrence: firstly, with newer generation bare metal stents, and then drug-eluting stents and in more recent years drug-coated balloons have become the default treatment for ISR.

Restenosis is defined as a reduction in lumen diameter after PCI either with or without stent implantation. In case of no-stent strategy, it usually consists in vessel remodelling and elastic recoil; otherwise it is determined by an excessive tissue proliferation in the luminal vessel of the stent called “neointimal proliferation”, or by a new-occurring atherosclerotic process called “neoatherosclerosis”.

Use and advantages of DCB’s for ISR

Most current DCB’s elute paclitaxel, a drug that effectively inhibits smooth muscle cell proliferation and migration by irreversibly stabilizing intracellular microtubules, thus blocking cell replication during the metaphase and anaphase stages of mitosis. The advantages of this drug include a high lipophilia, a relative selectivity for smooth muscle cells and cytotoxic action limited for a few days only. However, the main advantage of DCB in the treatment of ISR is that no new stent scaffold is needed within the previously implanted stent.

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