Vol. 7, Issue 1, Part A (2025)

Background: In-stent restenosis has long been regarded as a formidable foe by interventional cardiologists. This research sought to identify potential causes of restenosis following stent implantation in real-world settings through clinical, angiographic, and intravascular ultrasound assessments of consecutive patients experiencing ISR in second-generation drug-eluting stents (DES).
Methods: The study was conducted on 60 patients, aged 19 to 65 years, comprising both sexes, who had FDA-approved second-generation drug-eluting stents (DES) with in-stent restenosis (ISR), and were compared to 60 controls who received FDA-approved second-generation DES without ISR.
Results: Findings showed that individuals in the ISR group had significantly higher rates of diabetes mellitus, dyslipidemia, body mass index above 30, smoking, non-adherence to medication regimens, elevated low-density lipoprotein cholesterol type C levels, triglycerides, radial access, multivessel disease, and calcific lesions compared to those in the non ISR group (p<0.05). Patients in the ISR group had significantly lower levels of aspirin plus clopidogrel, statins, ezetimibe and left ventricular ejection fraction (LVEF) compared to those in the non ISR group (p<0.05). The presence of diabetes, acute coronary syndrome, low LVEF, radial access for percutaneous coronary intervention (PCI), and high contrast volume used in PCI were found to be independent predictors of ISR.
Conclusions: The following parameters were predictors and risk factors for development of ISR in FDA approved second generation DES: DM, dyslipidemia, high BMI, active smoking, noncompliance with medications, lack of statins, ezetimibe use in medications, acute coronary syndrome presentation in the initial PCI, MVD, calcific coronary lesions, high levels of triglycerides, LDL-C and low LVEF.