Recent advances in coronary in-stent restenosis: a comprehensive narrative review
- 1Department of Coronary Heart Disease, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital)
Abstract
Coronary in-stent restenosis (ISR) remains an important limitation of percutaneous coronary intervention despite the use of drug-eluting stents. ISR is a heterogeneous process driven by neointimal hyperplasia, neoatherosclerosis, and mechanical factors such as stent underexpansion or fracture. Intravascular imaging, particularly IVUS and OCT, enables mechanism-guided lesion preparation and device selection, while metabolomics, molecular imaging, and circulating biomarkers are improving understanding of its biological heterogeneity. Adequate lesion preparation is fundamental, and drug-coated balloons and repeat drug-eluting stent implantation remain the principal treatment strategies. Adjunctive techniques such as intravascular lithotripsy may help in severely calcified or resistant underexpanded lesions. Emerging evidence also implicates sphingolipid metabolism, mitochondrial dysfunction, immune-inflammatory signaling, and systemic metabolic modulation in ISR, though clinical relevance requires validation. This review summarizes recent advances in the epidemiology, pathophysiology, risk factors, diagnosis, treatment, and prevention of ISR, emphasizing the shift from anatomy-based management toward mechanism-guided, individualized therapy.
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BibTeX
@article{du2026recent,
title = {{Recent advances in coronary in-stent restenosis: a comprehensive narrative review}},
author = {Mingliang Du and Hui Hui},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.2002465},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.2002465/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Recent advances in coronary in-stent restenosis: a comprehensive narrative review
AU - Mingliang Du
AU - Hui Hui
PY - 2026
DA - 2026/10/27
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.2002465
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.2002465/full
AB - Coronary in-stent restenosis (ISR) remains an important limitation of percutaneous coronary intervention despite the use of drug-eluting stents. ISR is a heterogeneous process driven by neointimal hyperplasia, neoatherosclerosis, and mechanical factors such as stent underexpansion or fracture. Intravascular imaging, particularly IVUS and OCT, enables mechanism-guided lesion preparation and device selection, while metabolomics, molecular imaging, and circulating biomarkers are improving understanding of its biological heterogeneity. Adequate lesion preparation is fundamental, and drug-coated balloons and repeat drug-eluting stent implantation remain the principal treatment strategies. Adjunctive techniques such as intravascular lithotripsy may help in severely calcified or resistant underexpanded lesions. Emerging evidence also implicates sphingolipid metabolism, mitochondrial dysfunction, immune-inflammatory signaling, and systemic metabolic modulation in ISR, though clinical relevance requires validation. This review summarizes recent advances in the epidemiology, pathophysiology, risk factors, diagnosis, treatment, and prevention of ISR, emphasizing the shift from anatomy-based management toward mechanism-guided, individualized therapy.
SN - 2297-055X
ER -