IN-STENT RESTENOSIS (ISR): THE PROBLEM AND POSSIBLE SOLUTIONS

Abstract

This review article is focused on instent restenosis (ISR); its pathogenesis and different modalities tried for
the treatment of this challenging problem. The dream of an effective treatment for ISR has eluded decades of
effort by an army of investigators. No matter how much skill, experience, time, and effort the interventionist
brings to the table, ISR can entirely reverse a perfect procedural result within months. Until now many
strategies like conventional balloon angioplasty, perfusion balloon angioplasty (prolonged inflation),
debulking of the lesion prior to balloon angioplasty using rotational or directional atherectomy, stent within
stent implantation and treatment with Laser have all been tried but non has proved to be a fully effective
solution to the problem or non has proved to be significantly superior to the other. However the efficacy
provided by vascular brachytherapy and antiproliferative effect of the drug eluting stents has offered a hope
to patients with in-stent restenosis