Ultrathin-strut drug-eluting stents are associated with lower revascularization rates than drug-coated balloons in non-focal in-stent restenosis.

Authors

Berhan Keskin, Aykun Hakgor, Atakan Dursun, Aysel Akhundova, Umeyir Savur, Ebubekir Yigitbay, Ozlem Onder, Beytullah Cakal, Zubeyde Bayram, Bulent Demir, Haci Murat Gunes, Ibrahim Oguz Karaca, Ekrem Guler, Bilal Boztosun

Published in

Frontiers in cardiovascular medicine. Volume 13. Pages 1865693. Epub Aug 03, 2026.

Abstract

In-stent restenosis (ISR) remains a significant clinical challenge despite advances in drug-eluting stent (DES) technology. Although current guidelines recommend drug-coated balloon (DCB) angioplasty or repeat DES implantation for DES-ISR, real-world data comparing DCB with newer-generation ultrathin-strut sirolimus-eluting stents (SES) are limited.
This retrospective, single-center study included consecutive patients with stable angina who underwent treatment for DES-ISR using either a paclitaxel-coated DCB or an ultrathin-strut SES between January 2015 and May 2025. The primary outcome was target-lesion revascularization (TLR). Secondary endpoints included major adverse cardiac events (MACE), defined as a composite of all-cause mortality, myocardial infarction, stroke, and TLR. Time-to-event analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression.
A total of 205 patients were included (DCB, n = 106; SES, n = 99), with a median follow-up of 863 days. In the overall cohort, TLR rates were comparable between groups. However, in the non-focal ISR subgroup, TLR was significantly higher in the DCB group compared with SES (34.1% vs. 12.7%, p = 0.024). Similarly, MACE rates were higher with DCB in non-focal ISR (39.0% vs. 18.2%, p = 0.041). No differences were observed in focal ISR. Multivariable analysis in the non-focal subgroup identified DCB treatment (HR 3.89, p = 0.006) as independent predictor of TLR. Kaplan-Meier analyses for TLR and MACE consistently demonstrated significantly worse outcomes with DCB in the non-focal ISR subgroup, whereas no significant differences were observed in focal ISR.
Ultrathin-strut SES was associated with lower TLR and MACE rates compared with DCB in non-focal DES-ISR, whereas outcomes were comparable in focal ISR. These findings highlight the importance of lesion characteristics and support a tailored approach to ISR management.

PMID:
42609246
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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