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Coronary in-stent restenosis: Current status and future strategies

Harry C. Lowe, FRACP, PhD^*, Stephen N. Oesterle, MD, FACC^* and Levon M. Khachigian, PhD^,*

^* Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
The Centre for Thrombosis and Vascular Research, University of New South Wales, Sydney, Australia

View larger version (178K): [in a new window]   Figure 1 In-stent restenosis after porcine coronary stenting. Nonatherosclerotic porcine coronary artery 30 days after stenting with oversized balloon. Vessel excised, processed in methylmethacrylate, cut, polished and stained with haemotoxylin and eosin (originally at 2x magnification). The injury score for each stent strut is shown according to the definitions: 0 = internal elastic lamina (IEL) intact, endothelium denuded, media compressed but not lacerated; 1 = IEL lacerated, media compressed but not lacerated; 2 = IEL lacerated, media lacerated, external elastic lamina (EEL) compressed but not lacerated; 3 = EEL lacerated, media contains large lacerations, stent strut may extend into the adventitia. The injury score for the vessel section is calculated as (total of individual stent strut injury scores) / (number of stent struts in section) and equals 21/10 = 2.1 based on the original description (38). L = lumen; M = media; N = neointima; S = stent strut; Th = thrombus.