Drug-Eluting Balloons or Stents for Bare-Metal Stent Restenosis.

D rug-eluting stents (DES) represent the gold standard device for percutaneous coronary intervention (1). Nevertheless, bare-metal stents (BMS) are still used in patients at high bleeding risk or if immediate surgery is pending, to allow shorter dual-antiplatelet therapy duration in comparison with DES. Furthermore, economic restraints and limited availability of DES in some regions justify continued use of BMS. Consequently, we will continue to encounter BMS in-stent restenosis (ISR), which may affect up to 30% of patients treated with these devices (2). The optimal treatment of ISR, irrespective of whether it affects BMS or DES, remains a matter of debate. Current guidelines consider treatment with drug-eluting balloons (DEB) or DES to be equally efficacious, without differentiating between BMS and DES restenosis (1). However, neointimal composition is different for BMS and DES ISR, which may affect the efficacy and safety of the interventional approach used for its treatment (3).