{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:52:16Z","timestamp":1792029136637,"version":"4.4.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Percutaneous coronary intervention (PCI) has evolved significantly over the past four decades. Since its inception, in-stent restenosis (ISR)\u2014the progressive reduction in vessel lumen diameter after PCI\u2014has emerged as the main complication of the procedure. Although the incidence of ISR has reduced from 30% at 6 months with bare-metal stents to 7% at 4 years with drug-eluting stents (DESs), its occurrence is relevant in absolute terms because of the dimensions of the population treated with PCI. The aim of this review is to summarize the emerging understanding of the biological pathways that underlie ISR. In-stent restenosis is associated with several factors, including patient-related, genetic, anatomic, stent, lesion, and procedural characteristics. Regardless of associated factors, there are common pathophysiological pathways involving molecular phenomena triggered by the mechanical trauma caused by PCI. Such biological pathways are responses to the denudation of the intima during balloon angioplasty and involve inflammation, hypersensitivity reactions, and stem cell mobilization particularly of endothelial progenitor cells (EPCs). The results of these processes are either vessel wall healing or neointimal hyperplasia and\/or neo-atherosclerosis. Unravelling the key molecular and signal pathways involved in ISR is crucial to identify appropriate therapeutic strategies aimed at abolishing the \u2018Achille\u2019s heel\u2019 of PCI. In this regard, we discuss novel approaches to prevent DES restenosis. Indeed, available evidence suggests that EPC-capturing stents promote rapid stent re-endothelization, which, in turn, has the potential to decrease the risk of stent thrombosis and allow the use of a shorter-duration dual antiplatelet therapy.<\/jats:p>","DOI":"10.1093\/ehjopen\/oead083","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T10:41:50Z","timestamp":1692873710000},"source":"Crossref","is-referenced-by-count":87,"title":["In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1260-1308","authenticated-orcid":false,"given":"Francesco","family":"Pelliccia","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University Sapienza , Viale del Policlinico 155, 00161 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-6010","authenticated-orcid":false,"given":"Marco","family":"Zimarino","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \u201cG. d\u2019Annunzio\u201d University , Viale Abruzzo, 332, 66100 Chieti , Italy"},{"name":"Department of Cardiology, \u201cSS. Annunziata Hospital\u201d , ASL 2 Abruzzo, Via dei Vestini, 66100 Chieti , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampaolo","family":"Niccoli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Parma , Piazzale S. Francesco, 3, 43121 Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doralisa","family":"Morrone","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa , Lungarno Antonio Pacinotti 43, 56126 Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"De Luca","sequence":"additional","affiliation":[{"name":"Division of Cardiology, AOU \u201cPoliclinico G. 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