Drug-coated balloon treatment of in-stent restenosis in complex severe cardiac allograft vasculopathy.

Cardiac allograft vasculopathy (CAV) is a leading cause of late graft failure with limited revascularization options and high rates of in-stent restenosis (ISR). This report details a 33-year-old heart transplant recipient with progressive CAV that underwent multiple prior revascularizations, including drug-eluting stents and coronary artery bypass grafting. He developed ISR of the right coronary artery stent, treated with paclitaxel drug-coated balloon (DCB) without further stenting. Follow-up at 3 and 9 months showed patent vessels without recurrent restenosis and preserved graft function. DCB may be a viable option for ISR in advanced CAV when additional stenting is undesirable. Larger studies are needed to define its long-term role.