ISR vs De Novo Lesion Treatment During OCT-Guided PCI: Insights From the LightLab Initiative

•Long-term outcomes after in-stent restenosis percutaneous coronary intervention are poor but limited granular procedural data exist.•Among 2592 OCT-guided PCIs involving 2944 lesions, 18% of PCIs were for ISR.•ISR PCI procedures were longer and with greater use of scoring/cutting balloons and atherectomy.•Nonetheless, final MSA and % expansion (4.4 vs 5.1 mm2and 80% vs 83%; P< .0001) were lower in ISR PCI.•OCT impacted operator decision-making in 94% of ISR PCIs.