In-stent restenosis: local drug delivery with a stent or balloon?

The emergence of drug-eluting stents (DES) has led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents (BMS) (1). Consequently DES have become the preferred strategy in contemporary percutaneous coronary intervention (PCI) (2). Although rates of ISR are at historical low levels, optimal management remains an important issue as PCI for ISR is associated with a worse prognosis than de novo coronary interventions (3).