PCI complications: restenosis

Percutaneous coronary intervention Microchapters
Home
Patient Information
Overview
Risk Stratification and Benefits of PCI
Preparation of the Patient for PCI
Equipment Used During PCI
Pharmacotherapy to Support PCI
Vascular Closure Devices
Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT
Post-PCI Management
Risk Reduction After PCI
Post-PCI follow up
Hybrid coronary revascularization
PCI approaches
PCI Complications
Factors Associated with Complications Vessel Perforation Dissection Distal Embolization No-reflow Coronary Vasospasm Abrupt Closure Access Site Complications Peri-procedure Bleeding Restenosis Renal Failure Thrombocytopenia Late Acquired Stent Malapposition Loss of Side Branch Multiple Complications
PCI in Specific Patients
Cardiogenic Shock Left Main Coronary Artery Disease Refractory Ventricular Arrhythmia Severely Depressed Ventricular Function Sole Remaining Conduit Unprotected Left Main Patient Adjuncts for High Risk PCI
PCI in Specific Lesion Types
Classification of the Lesion The Calcified Lesion The Ostial Lesion The Angulated or Tortuous Lesion The Bifurcation Lesion The Long Lesion The Bridge Lesion Vasospasm The Chronic Total Occlusion The Left Internal Mammary Artery Multivessel Disease Distal Anastomotic Lesions Left Main Intervention The Thrombotic Lesion
PCI complications: restenosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of PCI complications: restenosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on PCI complications: restenosis
CDC on PCI complications: restenosis
PCI complications: restenosis in the news
Blogs on PCI complications: restenosis
Directions to Hospitals Treating Percutaneous coronary intervention
Risk calculators and risk factors for PCI complications: restenosis

Editors-In-Chief: Alexandra Almonacid M.D.; Jeffrey J. Popma M.D.

Restenosis

In the setting of in-stent restenosis (ISR) after bare metal stent (BMS) implantation, the risk of recurrence can be predicted by the pattern of restenosis.

Classification

Table 1. Mehran Classification System

• Pattern I: Focal (≤ 10 mm in length) lesions
  • Ia : Restenosis within the stent
  • Ib : Restenosis at the edge of the stent
  • Ic : Restenosis at the articulation or gap
  • Id : Restenosis multifocal
• Pattern II: ISR >10 mm within the stent
• Pattern III: Includes ISR > 10 mm extending outside the stent
• Pattern IV: ISR totally occluded

Implications

The need for recurrent target lesion revascularization (TLR) increased with increasing ISR class, increasing from 19%, 35%, 50%, to 83% in classes I to IV, respectively (P <0.001).

Restenosis after drug eluting stent implantation is generally more focal than following bare metal stent placement, and, with the sirolimus eluting stent, more is commonly at the margin of the stent due to balloon injury that is not covered with stent.