Original ResearchVascular healing responses to paclitaxel coated balloons or everolimus eluting stents for the treatment of in-stent restenosis. Insights from optical coherence tomographyMcInerney, Angelaa; Salazar, Carlosa; Pérez-Vizcayno, María Joséa,b; Jimenez-Quevedo, Pilara; Jiménez-Valero, Santiagoc; Brugaletta, Salvatored; Romaguera, Rafaele; Nombela-Franco, Luisa; Travieso-Gonzalez, Alejandroa; Jerónimo-Baza, Adriána; Tirado-Conte, Gabrielaa; Fernández-Ortiz, Antonioa; Escaned, Javiera; Alfonso, Fernandof; Macaya, Carlosa; Gonzalo, Nievesa Author Information aDepartamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense bFundación Interhospitalaria para la Investigación Cardiovascular (FIC) cDepartamento de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid dDepartamento de Cardiología Intervencionista, Hospital Universitario Clínic, Barcelona eDepartamento de Cardiología Intervencionista, Hospital Universitario Bellvitge, L’Hospitalet de Llobregat, Barcelona fDepartamento de Cardiología Intervencionista, Hospital Universitario de la Princesa, Madrid, Spain Received 25 October 2021 Accepted 6 August 2022 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Nieves Gonzalo, MD, PhD, Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, C/ Martín Lagos s/n, 28040 Madrid, Spain, Tel: +0034913303000; e-mail: [email protected] Coronary Artery Disease: December 2022 - Volume 33 - Issue 8 - p 609-617 doi: 10.1097/MCA.0000000000001189 Buy SDC Metrics Abstract Background Treatment of in-stent restenosis (ISR) remains a significant challenge. Current options include repeat stenting or drug-coated balloons. However, there is a paucity of data regarding vascular healing after these strategies. We, aimed to compare optical coherence tomography (OCT)-based vessel healing after treatment with paclitaxel-coated balloons (PCB) or everolimus-eluting stents (EES). Methods An OCT substudy (baseline and 6–9 months) of patients from RIBS IV and RIBS V, two prospective multicenter, randomized controlled clinical trials comparing PCB vs. EES in patients with ISR was performed. Results Sixty-four patients were included (30 PCB and 34 EES). There were no differences in the baseline or angiographic characteristics between groups. Both groups had the same proportion of drug-eluting and bare-metal stent (BMS) ISR. Baseline OCT analysis did not show differences in the qualitative characteristics of the ISR nor the restenotic tissue burden. Follow-up OCT showed a larger mean lumen area in the EES group (6.03 ± 1.5 vs. 5.24 ± 1.3 mm2; P = 0.043) but no difference in angiographic restenosis (P = 0.66). Percentage tissue coverage was higher with PCB vs. EES (26 ± 13 vs. 19 ± 11%; P = 0.031). EES-treated ISR more frequently had uncovered struts at follow-up [21 (72%) vs. 12 (44%); P = 0.034]. Tissue covering struts more frequently had a high backscatter structure after PCB [21 (78%) vs. 16 (55%); P = 0.07]. Conclusions Compared with EES, ISR treated with PCB demonstrated more strut coverage with mainly high backscattering tissue. Larger OCT-defined neointimal proliferation in PCB-treated ISR did not translate into higher angiographic restenosis rates. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.