I do not always perform the post-dilatation. Only in very proximal obstructions or some luminal reduction is visible after treatment.
First - not always - probably 30 - 40% cases , especilly - during IVUS guiding procedure
I would suggest to use a drug eluting balloon for in-stent restenosis.
Given that, if you correctly predicate the lesion, I think you do not need to postdilate it after DES implantation, unless you have an impaired angiographic/IVUS/OCT result.
If there is a residual stenosis then I use NC balloon for post-dilation with inflation pressure roughly 20 atm.
Dear Josef. I agree with you. In these cases I use frequently 25 atm.
We use mostly bare metal stents and tend to treat ISR with balloon dilatation at no less than 12 Atm for long time (not less than 60 sec). If the immediate angiographic result is not good we increase the inflation pressure. If the patient comes for a second time with ISR or if it is a lesion that would cause considerable ischaemia (i.e. proximal LAD) we use the drug eluting balloon at high pressure with long dilation.
Sometimes balloon dilatation may give false result as the recoil phenomenon may reduce the desired lumen expansion. Best if there is IVUS/OCT guidance, failing which, some cutting balloon or rotablation may give better result in addition to drug coated balloon/stent
If the new stent is deployed beyond the edges of the restenosed stent we always perform a post-dilation with a NC balloon. This because we have seen at OCT a high probability of malapposition in the portion of the new stent protruding outside of the edges of the old stent. On the contrary, when the new stent is implanted within the edges of the old one (i.e. only on the restenotic tissue) the odd of malapposition is very low and there is no need for a NC postdilation (DESERT trial, NCT01243099, submitted).
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