In-stent Restenosis: COMBO Stent May Guarantee a Proper Healing


  • Davide Piraino AOUP "Paolo Giaccone", Palermo, Italy
  • Dario Buccheri
  • Gregory Dendramis
  • Bernardo Cortese
  • Giuseppe Andolina



Intra-stent restenosis, Drug-eluting balloon, COMBO-stent, Intravascular ultrasonography.


The risk of ISR appears to be related to several factors which cooperate synergistically; among these factors an important role is played by: the metal struts of the stent and the consequent inflammatory stress on the vascular wall which favors an excessive neointimal proliferation that "attacking" the stent struts, progressively and critically reduce the vessel lumen.
Drug eluting balloon is the gold standard in this setting due to the absence of metallic struts. COMBO stent could be a viable alternative which may properly compare to DEB in the ISR treatment: one of a kind, because it has a dual therapy action, synergistically combining the effect of sirolimus with the presence of CD34+ antibodies on the surface of its struts, capturing circulating endothelial progenitor cells (EPCs), so mobilized EPCs differentiate into functional endothelium and allowing a homogeneous neointimal formation.
Here we are presenting an intriguing case of a ISR treated successfully with COMBO and confirmed by 5-months angiographic and IVUS follow-up. 


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