{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:15:35Z","timestamp":1793330135290,"version":"4.5.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,11,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite improvement in devices, in\u2010stent restenosis remains a frequent and challenging complication of percutaneous coronary interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The RESTO (Morphological Parameters of In\u2010Stent Restenosis Assessed and Identified by OCT [Optical Coherence Tomography]; study NCT04268875) was a prospective multicenter registry including patients presenting with coronary syndromes related to in\u2010stent restenosis. All patients underwent preintervention OCT analysis, which led to analysis of in\u2010stent restenosis phenotype, number of strut layers, and presence of stent underexpansion. The primary end point was the in\u2010stent restenosis type according to the OCT morphological classification. The 1\u2010year incidence of target vessel failure (a composite of death from cardiac causes, target\u2010vessel myocardial infarction, or ischemia\u2010driven target\u2010vessel revascularization) was assessed. The study included 297 patients. The culprit stent was a drug\u2010eluting stent in 74.2% of cases. OCT analysis revealed the presence of neoatherosclerosis in 57% (52% calcified), neointimal hyperplasia in 43% (58% homogeneous), stent underexpansion (minimal stent area &lt;4.5\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      ) in 43%, and multiple stent layers in 30%. The prepercutaneous coronary intervention OCT analysis modified the operator's strategy for management in 30% of cases. Treatment involved drug\u2010eluting stent implantation in 61.6% and drug\u2010eluting balloon angioplasty in 36.1% of cases with only 63.2% optimal results. The 1\u2010year target vessel failure incidence was 11% (95% CI, 9%\u201313%). Residual postpercutaneous coronary intervention stent underexpansion was associated with significantly higher target vessel failure incidence (19% [95% CI, 14%\u201324%] versus 7% [95% CI, 5\u20139],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">OCT identified neoatherosclerosis and neointimal hyperplasia in comparable proportions. Stent underexpansion was frequent and favored subsequent adverse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.036065","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T07:06:48Z","timestamp":1729840008000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Stent Underexpansion Is an Underestimated Cause of Intrastent Restenosis: Insights From RESTO Registry"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5226-6076","authenticated-orcid":false,"given":"G\u00e9raud","family":"Souteyrand","sequence":"first","affiliation":[{"name":"University Hospital Gabriel Montpied","place":["Clermont\u2010Ferrand, 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