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In-Stent Restenosis
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • In-stent restenosis (ISR)
          • Definitions

            • Stenosis > 50% diameter reduction of coronary artery lumen inside or at edges of implanted stent
            • 2 different morphologies
              • Focal ISR: Short stenosis anywhere within stent
              • Diffuse ISR: Stenosis along entire length of implanted stent

          IMAGING

          • CT Findings

            • MR Findings

              • Echocardiographic Findings

                • Angiographic Findings

                  • Nuclear Medicine Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Dai T et al: Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol. 28(4):1373-82, 2018
                                      2. Mannil M et al: Photon-Counting CT: High-Resolution Imaging of Coronary Stents. Invest Radiol. 53(3):143-9, 2018
                                      3. Bangalore S et al: The state of the absorb bioresorbable scaffold: consensus from an expert panel. JACC Cardiovasc Interv. 10(23):2349-59, 2017
                                      4. Hickethier T et al: Monoenergetic reconstructions for imaging of coronary artery stents using spectral detector CT: In-vitro experience and comparison to conventional images. J Cardiovasc Comput Tomogr. 11(1):33-9, 2017
                                      5. von Spiczak J et al: Coronary artery stent imaging with CT using an integrated electronics detector and iterative reconstructions: first in vitro experience. J Cardiovasc Comput Tomogr. 7(4):215-22, 2013
                                      6. Andreini D et al: Coronary in-stent restenosis: assessment with CT coronary angiography. Radiology. 265(2):410-7, 2012
                                      7. Chung SH et al: Evaluation of coronary artery in-stent restenosis by 64-section computed tomography: factors affecting assessment and accurate diagnosis. J Thorac Imaging. 25(1):57-63, 2010
                                      8. de Graaf FR et al: Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography to noninvasively assess in-stent restenosis. Invest Radiol. 45(6):331-40, 2010
                                      9. Sun Z et al: Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: a meta-analysis. Eur J Radiol. 73(2):266-73, 2010
                                      10. Serruys PW et al: A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods. Lancet. 373(9667):897-910, 2009
                                      11. Hoffmann R et al: Coronary in-stent restenosis - predictors, treatment and prevention. Eur Heart J. 21(21):1739-49, 2000
                                      12. Mehran R et al: Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 100(18):1872-8, 1999
                                      13. Hoffmann R et al: Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation. 94(6):1247-54, 1996
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • In-stent restenosis (ISR)
                                              • Definitions

                                                • Stenosis > 50% diameter reduction of coronary artery lumen inside or at edges of implanted stent
                                                • 2 different morphologies
                                                  • Focal ISR: Short stenosis anywhere within stent
                                                  • Diffuse ISR: Stenosis along entire length of implanted stent

                                              IMAGING

                                              • CT Findings

                                                • MR Findings

                                                  • Echocardiographic Findings

                                                    • Angiographic Findings

                                                      • Nuclear Medicine Findings

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              • Microscopic Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Dai T et al: Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol. 28(4):1373-82, 2018
                                                                          2. Mannil M et al: Photon-Counting CT: High-Resolution Imaging of Coronary Stents. Invest Radiol. 53(3):143-9, 2018
                                                                          3. Bangalore S et al: The state of the absorb bioresorbable scaffold: consensus from an expert panel. JACC Cardiovasc Interv. 10(23):2349-59, 2017
                                                                          4. Hickethier T et al: Monoenergetic reconstructions for imaging of coronary artery stents using spectral detector CT: In-vitro experience and comparison to conventional images. J Cardiovasc Comput Tomogr. 11(1):33-9, 2017
                                                                          5. von Spiczak J et al: Coronary artery stent imaging with CT using an integrated electronics detector and iterative reconstructions: first in vitro experience. J Cardiovasc Comput Tomogr. 7(4):215-22, 2013
                                                                          6. Andreini D et al: Coronary in-stent restenosis: assessment with CT coronary angiography. Radiology. 265(2):410-7, 2012
                                                                          7. Chung SH et al: Evaluation of coronary artery in-stent restenosis by 64-section computed tomography: factors affecting assessment and accurate diagnosis. J Thorac Imaging. 25(1):57-63, 2010
                                                                          8. de Graaf FR et al: Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography to noninvasively assess in-stent restenosis. Invest Radiol. 45(6):331-40, 2010
                                                                          9. Sun Z et al: Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: a meta-analysis. Eur J Radiol. 73(2):266-73, 2010
                                                                          10. Serruys PW et al: A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods. Lancet. 373(9667):897-910, 2009
                                                                          11. Hoffmann R et al: Coronary in-stent restenosis - predictors, treatment and prevention. Eur Heart J. 21(21):1739-49, 2000
                                                                          12. Mehran R et al: Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 100(18):1872-8, 1999
                                                                          13. Hoffmann R et al: Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation. 94(6):1247-54, 1996