Drug eluting Balloon versus second generation drug eluting stents for in-stent restenosis

Until results of DARE and RIB 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 eluting balloon.

Results of this metanalysis are superiority of paclitaxel eluting balloon over plane balloon angioplasty and also paclitaxel eluting stent.

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 choice

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

Lisa Nainggolan. Drug-eluting balloon: Best option for in-stent restenosis? . theheart.org

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