A step forward: imaging-based approach to in-stent restenosis

In-stent restenosis (ISR) remains a common problem in contemporary practice despite significant advances in interventional tools and techniques1. ISR is not a binary finding, however, and we have evolved from simply stratifying ISR based on focal or diffuse patterns, to specific patterns based on intravascular imaging appearance including neointimal hyperplasia, calcified or non-calcified neoatherosclerosis and underexpansion2,3. In fact, recognition of the predominant lesion morphology has important treatment implications guiding optimal therapy.

In the present issue of EuroIntervention, Xhepa and colleagues evaluated, in a multicentre, optical coherence tomography (OCT)-based registry of lesions treated for in-stent restenosis (ISR), the role ...