Biomarker screening and intervention window for iliac vein stent restenosis: a systematic review of evidence-based advances

Iliac vein stent restenosis (ISR) remains a significant complication following stent placement for iliac vein compression syndrome (Rajput et al. in Cardiovasc Diagn Ther. 11:1103–1115, 2021) and post-thrombotic syndrome, with reported 1-year incidence rates of 18%-30%. This systematic review synthesizes evidence from the past five years to evaluate advances in predictive biomarker discovery, the concept of an optimal intervention window, and emerging therapeutic strategies. A comprehensive literature search identified 127 relevant studies. Our analysis reveals that combined biomarker models incorporating inflammatory cytokines (e.g., IL-6), microRNA panels (e.g., miR-92a/126), and coagulation-fibrosis markers (e.g., TAT, TGF-β1) show promising predictive value (pooled AUC up to 0.84), though clinical validation remains limited. Pathophysiological and computational modeling suggests a critical "subclinical stenosis phase" may exist 3-6 months post-stenting, during which interventions might be more effective, but robust clinical trial data supporting specific timing is scarce. While drug-eluting stents reduce short-term ISR rates, long-term safety concerns persist. Novel approaches, including bioresorbable materials and targeted biological therapies, are primarily in preclinical stages. This review underscores the urgent need for standardized biomarker validation, prospective trials to define intervention timing, and interdisciplinary collaboration to translate mechanistic insights into improved clinical outcomes for ISR prevention and management.