Until results of DARE
IV are known answer this question is still speculative. From meta analysis
of 5 studies which included 801 patients with in-stent restenosis who had previously
received BMS two studies and DES in three studies, and subsequently received
plane balloon angioplasty or paclitaxel eluting stent or paclitaxel
Results of this metanalysis are superiority of
paclitaxel eluting balloon over plane balloon angioplasty and also paclitaxel
Paclitaxel eluting balloon was superior in patients
in whom initial stent was BMS and for patients with initial DES, paclitaxel
eluting balloon and paclitaxel eluting stents had same efficacy.
One drawback for paclitaxel eluting stent for in-stent
restenosis was multilayer stents and side branch occlusion issue.
Paclitaxel eluting balloon seems to be good choice
if one is dealing initial BMS and side branch issue is present.
As compared to second generation DES paclitaxel
eluting balloon are much cheaper so paclitaxel eluting balloon may better
However ACC/AHA/Society for Cardiac Angiography and
Interventions and the ESC advise use of DES for in-stent restenosis regardless
of whether the initial stent was a BMS or a DES
Drug-eluting balloon: Best option for in-stent restenosis? . theheart.org.
Labels: For Doctors, Invasive Cardiology