Prevention and treatment of neurovascular in-stent stenoses: review of the concepts.

Advances in medical devices technology now allow the endovascular treatment of stenotic lesions of the intracranial arteries with the help of the implantation of microstents. The technical development in stent, catheter and guidewire technology now allows the application of these devices in the intracranial arteries, where access issues due to difficult anatomy and length of the access pathway pose far more hurdles to accurately, efficiently and safely navigate these devices as compared with the treatment of lesions of the peripheral arteries or the coronary system. Although the efficacy and safety of these procedures show a continuous improvement with decreased periprocedural complication rates, the development of a significant intraluminal stenotic lesion as a result of neointimal hyperplasia induced within the implants remains a serious delayed complication. In this review, the authors give an overview of the factors affecting the development of neointimal hyperplasia and review the currently available possibilities of the prevention as well as the treatment of the already existing intraimplant stenotic lesions.