The advent of percutaneous coronary intervention (PCI) and intracoronary stent development marked a pivotal milestone in the management of acute coronary syndromes, significantly reducing morbidity and mortality worldwide. However, despite ongoing advancements in stent technology, treatment modalities, and diagnostic tools, in-stent restenosis (ISR) remains a prevalent and challenging clinical issue, contributing substantially to the burden of cardiovascular disease. This review provides a comprehensive background of ISR, including its associated risk factors, pathophysiology, and current management strategies. By addressing gaps in ISR management, this review critically evaluates existing approaches and explores potential directions for advancing the field of interventional cardiology. Additionally, supporting data for these strategies are examined, and a diagnostic and treatment algorithm is proposed to guide complex clinical decision-making.
Keywords: Coronary artery disease; In stent restenosis; Percutaneous coronary intervention.
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