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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Introduction to ISR in Cardiology
Introduction
In-stent restenosis (ISR) is the re-narrowing of an artery after a stent has been placed to keep it open. This usually happens due to excessive tissue growth inside the stent, leading to a reduction in blood flow.
Causes of ISR
The main reasons for ISR include: - Excessive cell growth (neointimal hyperplasia) - Chronic inflammation leading to scar formation - Poor stent deployment (stent under-expansion) - Diabetes and other comorbid conditions
Symptoms of ISR
Patients with ISR may experience: - Recurring chest pain (angina) - Shortness of breath - Fatigue - Signs of a heart attack in severe cases
Diagnosis of ISR
Diagnosis typically involves: - Coronary Angiography (gold standard) - Intravascular Ultrasound (IVUS) - Optical Coherence Tomography (OCT) for detailed stent evaluation - Non-invasive Stress Testing in suspected cases
Treatment Options
There are several ways to manage ISR:
1. Drug-Coated Balloon (DCB) Angioplasty
- Used to deliver anti-proliferative drugs to prevent further tissue regrowth.
2. Placement of a New Stent (Re-stenting)
- If the original stent is under-expanded or poorly placed, another stent may be needed.
3. Coronary Artery Bypass Grafting (CABG)
- Considered in severe cases or when multiple restenosis events occur.
4. Medical Therapy
- Use of antiplatelet drugs, statins, and high-intensity lipid-lowering therapy.
Prevention of ISR
To reduce the risk of ISR, patients should: - Take prescribed dual antiplatelet therapy (DAPT) (aspirin + P2Y12 inhibitors) - Adhere to a heart-healthy diet - Control risk factors such as diabetes and hypertension - Avoid smoking and engage in regular physical activity
Conclusion
ISR is a challenging complication after coronary stent placement, but with proper diagnosis, treatment, and prevention strategies, its impact can be minimized. Regular follow-up with a cardiologist is essential.
Source recommendations
1. European Society of Cardiology (ESC) Guidelines on Myocardial Revascularization
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-EACTS-Guidelines-in-Myocardial-Revascularisation-Guidelines-for
- https://academic.oup.com/eurheartj/article/40/2/87/5079120
- https://pubmed.ncbi.nlm.nih.gov/30165437/
- https://www.heartuniversity.org/guidelines/esc-eacts-guidelines-on-myocardial-revascularization-2018-the-task-force-on-myocardial-revascularization-of-the-european-society-of-cardiology-esc-and-european-association-for-cardio-thoracic-surge/
- https://pubmed.ncbi.nlm.nih.gov/25173339/
2. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Coronary Artery Disease Management
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
- https://www.acc.org/Guidelines
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001038
- https://www.acc.org/
- https://pubmed.ncbi.nlm.nih.gov/27026020/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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