Restenosis in a Bare-Metal Stent

The idea of adding another metallic layer to correct a failed stent is not so appealing; therefore, any attempt to propose a metal-free strategy is laudable. The initial strategy to perform plain balloon angioplasty to treat bare-metal in-stent restenosis (ISR) was inadequate, leaving the remaining options of implanting a drug-eluting stent or using a drug-eluting balloon (DEB).1–4 Pleva et al5 report, in this issue of Circulation: Cardiovascular Interventions , the results of a study randomizing 136 patients with bare-metal ISR to treatment with a DEB (Sequent Please; B. Braun AG, Melsungen, Germany) or an everolimus-eluting stent (EES; Promus Element; Boston Scientific, Marlborough, MA.)See Article by Pleva et al There were 74 ISR lesions (>50% diameter stenosis) in each group. The primary end point was in-segment late lumen loss at 12 months measured by quantitative control angiography. The decision to evaluate late lumen loss as an end point is open to debate because the acute gain, and therefore late loss, is lower with DEB compared with EES. The selection of minimal lumen diameter at follow-up …