Background

In-stent restenosis (ISR) remains a significant challenge in interventional cardiology despite major advances in stent technology, intravascular imaging, pharmacotherapy, and procedural techniques. Although the introduction of drug-eluting stents (DES) has substantially reduced restenosis rates compared with bare-metal stents (BMS), ISR continues to affect approximately 5–15% of patients undergoing percutaneous coronary intervention (PCI).

Objective

This study aims to review contemporary predictors of ISR, including patient-related, lesion-related, procedural, biological, and device-specific factors, and to evaluate current strategies for prevention and management.

Methods

A comprehensive review of clinical trials, registries, meta-analyses, and contemporary guideline recommendations was conducted. Major predictors of ISR and their mechanisms were analyzed.

Results

Diabetes mellitus, chronic kidney disease, complex coronary lesions, small vessel diameter, long lesion length, stent underexpansion, residual plaque burden, and inflammatory responses remain major predictors of ISR. Advanced imaging modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have improved understanding of ISR mechanisms and prevention strategies.

Conclusion

ISR remains a multifactorial phenomenon involving patient, lesion, device, and procedural factors. Personalized risk assessment and optimized PCI techniques are essential for reducing ISR incidence and improving long-term cardiovascular outcomes.