| Summary: | The use of drug-eluting stents (DES) for the treatment of coronary artery stenosis substantially reduced the need for repeat revascularization compared to bare-metal stents.1 However, as many patients undergoing stenting have long life expectancy, and the incidence rate of stent failure increases with time since implantation, the number of patients presenting with DES restenosis is not insignificant and the treatment of these patients remains a challenge.2 Current clinical practice guidelines recommend treatment of restenosis associated with angina or ischemia by repeat revascularization with either repeat stenting with DES or angioplasty with drug coated balloon (DCB).3 Certain situations favour repeat stenting with DES, most notably loss of mechanical integrity of the restenosed stent. In general, however, although repeat stenting with DES may be more effective than angioplasty with DCB in the short-to-medium-term,4 avoidance of additional stent layers is an important consideration in the longer-term. Indeed, many centres prefer DCB angioplasty as a first-line approach for the treatment of restenosis in the absence of a compelling indication for repeat stenting. The efficacy of DCB treatment relies on rapid transfer and subsequent tissue retention of the anti-proliferative agent, which is necessary for a persistent suppression of cell proliferation.5 Preclinical data suggest that micro-injuries to the...
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