skip to main content

Drug-coated Balloon for ISR — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCoronary Artery DiseaseDrug-coated Balloon for ISREECC

A 52-year-old woman presents with recurrent chest pain 2 years after DES implantation. Angiography shows a diffuse 80% in-stent restenosis (ISR) pattern. IVUS confirms neointimal hyperplasia. What is the preferred percutaneous treatment strategy for DES ISR?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Drug-coated balloon (DCB) angioplasty

Drug-coated balloons (DCB) are the preferred strategy for DES in-stent restenosis based on the ISAR-DESIRE 3, RIBS IV, and other trials. DCBs deliver antiproliferative drug (paclitaxel) to the vessel wall without adding additional metal layers, addressing the neointimal hyperplasia driving ISR. An alternative is repeat DES implantation (a 'stent sandwich'), which is supported by similar evidence but adds more metal and may create further challenges if recurrent ISR develops. The 2024 ESC CCS Guidelines recommend either DCB or DES for ISR (Class I). Bare-metal stents have unacceptably high re-restenosis rates and are not recommended.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes