One of the main causes of failure of angioplasty with stent implantation is in-stent restenosis (ISR). Even though its incidence has considerably decreased in recent years, it remains the Achilles’ heel of the interventional approach in patients with coronary disease.

We aimed to determine the predisposing factors of the different types of restenosis and evaluate the comparative efficacy and safety of the 2 most frequently used treatments of stent restenosis: drug-eluting balloon (DEB) and placement of a new drug-eluting stent (redo-DES).

A prospective longitudinal analytical bicentric study, including all consenting patients presenting on coronary angiography in-stent restenosis, whether in the context of the exploration of stable angina or acute coronary syndrome. The different characteristics, mechanisms (analysis of initial PCI procedure, stent enhancement, and IVUS) management, and prognosis were noted. An angiographic control was systematically carried out between 6 and 12 months in patients treated with a Redo-DES or DEB (Fig. 1).

A total of 73 patients were evaluated: the mean age was 61.3±10.2 years and 80.8% were male. The more frequent risk factor was diabetes with 67.1% (47 patients), and the main clinical presentation was CCS in 56.2% (41patients). The mean delay of in-stent restenosis occurrence was 20 months (4–48 months). The related artery includes the LAD in 61.6% and the two main characteristics of the initial lesion were calcified in 68.5% and the longest (>24 mm) in 53.4% of patients. Stent under expansion was the most found mechanism in 54.8%. More than a half of the patients were treated with Redo-stenting and 34.2% with a DEB. The angiographic control was good with only two significant redo-restenosis in patients treated with a DEB and three in patients treated with a DES.

Diabetes mellitus, calcified and long lesions are the most important factors related to in-stent restenosis. Stent under expansion was the most found mechanism. Redo-stenting and DEB are safe and efficient treatments.