How to prevent recurrence of in-stent re-steneosis coronary artery or to have a new coronary lesion?

many factors should be kept in mind to prevent ISR or new llesion: *pt risk factors should be controlled *pt compliance to medications specially Statin AND antiplat.(any drug resistance). *lasion factors: by avoid long lesion ,consider that small lesions may increase the rate of ISR and well prepreparations of lesions. *procedural factors are vital,the perocedure must perform in proper way and optimized to decrease the risk of ISR.(apposition,sizing,barotruama,adge dissection and etc) *Use of new generations of DES *once IRS occured use similar DES TO TREAT (or newer one at least).consider the role of DEB.

Treating in-stent restenosis by drug eluting balloon with strict control of cardiovascular risk factors especially diabetes. Objective of LDL less than 0.7g/l with statins.

If there is recurrence, stent in stent by drug elting stents with other limus. 

After that we can consider intra-stent laser therapy.

By using new dual antiplatelet therapy for longer duration , 

by implanting new generation drug eluting stents, drug coated balloons

intra coronary radiation therapy which has proven to be effective especially in diabetic patients