PCI complications: restenosis

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Editors-In-Chief: Alexandra Almonacid M.D. and Jeffrey J. Popma M.D.

Restenosis Pattern

In the setting of in-stent restenosis (ISR) after bare metal stent (BMS) implantation, the risk of recurrence can be predicted by the pattern of restenosis (1, 2).

Classification System

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Table 1. Mehran Classification System (1)

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• Pattern I: Focal (≤ 10 mm in length) lesions
  • Ia : Restenosis within the stent
  • Ib : Restenosis at the edge of the stent
  • Ic : Restenosis at the articulation or gap
  • Id : Restenosis multifocal
• Pattern II: ISR >10 mm within the stent
• Pattern III: Includes ISR > 10 mm extending outside the stent
• Pattern IV: ISR totally occluded

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Implications

The need for recurrent target lesion revascularization (TLR) increased with increasing ISR class, increasing from 19%, 35%, 50%, to 83% in classes I to IV, respectively (P <0.001) (1).

Restenosis after drug eluting stent implantation is generally more focal than following bare metal stent placement (3, 4), and, with the sirolimus-eluting stent, more is commonly at the margin of the stent due to balloon injury that is not covered with stent (3, 5).

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