Coronary in-stent restenosis—predictors, treatment and prevention

Stent implantation in human coronary arteries, initiated in 1986 by Sigwart et al. is intended to reduce coronary restenosis. High pressure balloon inflations and antithrombotic pharmacological regimens have almost abolished subacute thrombosis and the associated anticoagulation-related bleeding. This has resulted in acceptance of coronary stents as primary catheter-based therapy. It is not an exaggeration to claim that interventional therapy has been revolutionized in a wave of ‘stent mania’ with the number of lesions treated with stents exceeding 50% of all interventional procedures. Although stents have been demonstrated to reduce restenosis compared to balloon angioplasty, in-stent restenosis occurs in about 10–60% of cases. As a result, in-stent restenosis has developed into a significant clinical problem. It has been estimated that up to 250 000 patients developed in-stent restenosis in 1999 alone.