Background: In-stent restenosis (ISR) remains an important complication of percutaneous coronary intervention. Drug-eluting balloon (DEB) angioplasty and repeat drug-eluting stent (DES) implantation are established treatment options, but comparative real-world data from Iraq are limited. This study aimed to compare baseline characteristics and six-month clinical and angiographic outcomes of patients with coronary ISR treated with DEB versus repeat DES
implantation.
Methods: This prospective observational study included 200 adults with angiographically confirmed ISR treated in Kirkuk, Iraq, between November 2023 and November 2024. One hundred patients underwent DEB angioplasty and 100 underwent repeat DES implantation in routine practice. Clinical outcome data at six months were available for all patients, and follow-up angiography was performed in 78 DEB-treated and 79 DES-treated patients. The primary
clinical outcome was major adverse cardiac events (MACE), defined as the composite of target vessel revascularization, myocardial infarction, and all-cause death.
Results: DES-treated patients had a longer median time to restenosis and a higher prevalence of insulin-dependent diabetes mellitus and family history of coronary artery disease, whereas hypertension was more common in the DEB group. At six months, minimal lumen diameter, late lumen loss, binary restenosis, and target lesion revascularization were comparable between groups. However, TVR and MACE were significantly higher in the DES group. Myocardial infarctions were infrequent and similar in both groups.
Conclusion: DEB and repeat DES showed comparable six-month angiographic outcomes and target lesion revascularization rates. Higher TVR and MACE rates in the DES group may reflect baseline risk differences rather than a device-specific effect.