Podcast #6 · 29 Jun 2026
AngioClub: A Multimodality Approach to Recalcitrant In-Stent Restenosis
- In-Stent Restenosis (ISR)
- Interventional Cardiology (IC)
- Balloon Angioplasty
- Brachytherapy
- Intravascular Lithotripsy (IVL)
- Intravascular Ultrasound (IVUS)
- Excimer Laser Coronary Atherectomy (ELCA)
- Rotational Atherectomy
CathMasters discuss a challenging case of recalcitrant focal in-stent restenosis (ISR) within two layers of stent in a right coronary artery. The panel walks through a systematic approach to ISR: guide selection and access strategy; the role of intracoronary imaging in classifying ISR using the Waksman mechanistic classification; and a stepwise lesion-modification algorithm using cutting balloons, excimer laser coronary atherectomy (ELCA), and intravascular lithotripsy (IVL). The discussion concludes with the contemporary role of drug-coated balloons (DCB) versus vascular brachytherapy (VBT), and when to consider rotational atherectomy (RA) for stent ablation in refractory cases.