In-stent Restenosis (ISR)

What is Restenosis?

Restenosis means that a section of blocked artery that was opened up with angioplasty or a stent has become narrowed again.

There are many treatment options in Malaysia for patients who have restenosis after receiving a stent. The first step in treatment is meeting with an experienced cardiac interventionist (a doctor who performs procedures to open up clogged arteries). The doctor can determine the best type of treatment based on the location of the blocked stent, how badly it is blocked, and information about the patient (such as age, type of cardiovascular disease, and other medical conditions). The doctor will perform a catheterization and can use tests during the procedure to get more information about the blockage by looking inside the artery. These tests include intravascular ultrasound (IVUS) and optical coherence tomography (OCT).


What are the treatment options for in-stent restenosis?


If an interventional procedure is needed, the approach will vary depending on if the original stent(s) were fully expanded, how many stents are overlapped, and the length of the re-blockage.

Non-Surgical Options It is possible that the stent was not put in place correctly or that it did not expand the way it should have. An IVUS or OCT can help check to see if either of those problems exist. If so, sometimes the solution is simply re-expanding the stent. This can be done with a high pressure balloon (sometimes assisted by laser to loosen up the firm tissue around the stent). If the stent was well-expanded and the problem is tissue regrowth inside the stent, the best treatment option is often placement of another drug-eluting stent (DES). However, the risk of reblockage increases with the number of overlapping stents. If 2-3 stents are already in place, we usually recommend brachytherapy or occasionally drug-eluting balloon use. Shorter blockages tends to respond better to all of these approaches.

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