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Conventional coronary balloon angioplasty, introduced 20 years ago, has been suffered from abrupt vessel closure and restenosis. Of all devices currently available, only intracoronary stenting has demonstrated a significant reduction in the occurrence of restenosis during follow-up in limited patient subset. However, intracoronary stenting will be used in more complex and in smaller arteries. Improved stent deployment technique and optimisation of postprocedural management have dramatically improved the safety of intracoronary stenting. Despite this, restenosis still occurs within the stented coronary artery, due predominately to lumen encroachment by neointimal hyperplasia with minimal contribution of chronic stent recoil. Therefore, we are in a first step of restenosis prevention, the management and prevention of in-stent restenosis are still in active investigation. We must continue animal studies to investigate the cellular and molecular events induced by stent-related vascular injury and repair. Clinical trials that compare the stent designs and deployment protocols will be essential. Pharmacological or genetic interventions, and irradiation treatment to prevent in-stent restenosis must be pursued. Finally, optimal treatment for in-stent restenosis, including balloon angioplasty, ablative therapies, or repeat stenting must be evaluated.
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