The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.

药物洗脱支架技术的引入和后续迭代大大提高了经皮冠状动脉介入治疗的疗效和安全性。然而，支架内再狭窄 (ISR) 的发生率和由此产生的重复血运重建仍以每年 1%-2% 的速度发生。鉴于全球每年植入数百万个药物洗脱支架，ISR 可被视为具有公共卫生意义的病理实体。ISR 的机制是多方面的。自从首次描述 ISR 的血管造影模式以来，冠状动脉内成像的出现进一步阐明了 ISR 的机制和模式。ISR 的设备和治疗策略也随着时间的推移而发展。目前，建议采用个性化方法使用冠状动脉内成像来表征 ISR 的底层基质。在本文中，我们全面回顾了 ISR 的发生率、机制和影像学特征，并提出了当代治疗算法。