Risk factors,pathogenic mechanisms and treatment progress of coronary in-stent restenosis

Coronary artery disease (CAD) has become one of the leading causes of death worldwide.Percutaneous coronary intervention (PCI) is one of the main treatments for CAD. Coronary in-stent restenosis(ISR) refers to the re-narrowing of the artery following PCI, occurring in approximately 10% of cases. Coronary ISR is a highly complex condition, and while its exact pathogenesis remains unclear, it is widely believed to involve processes such as inflammation, proliferation and stromal vascular remodeling. Several risk factors have been identified as being associated with coronary ISR, including inflammation, genetic predisposition, plaque heterogeneity, and improper stent placement during PCI. These factors not only help categorize patient risk but also deepen our understanding of coronary ISR,aiding in the development of individualized treatment plans.Over the past four decades, numerous new materials and techniques have been employed to prevent and treat coronary ISR, including drug eluting stents, innovative pharmacotherapies, advanced intravascular imaging techniques,biodegradable stents, as well as cell and gene therapies. Despite these advancements, coronary ISR remains a significant PCI complication. Thus, recognizing the risk factors, understanding the pathogenic mechanisms, and exploring new treatment strategies for coronary ISR are critical. This article aims to review the latest advancements in the risk factors, pathogenic mechanisms, and treatment of coronary ISR, providing reference for clinicians and future researchers.