Garcia-Guimaraes M, et al. - Researchers used optical coherence tomography (OCT) and examined 75 consecutive patients with 81 in-stent restenosis (ISR) lesions before reintervention (from January 2014 to August 2016), to evaluate prevalence, predictors, and implications of calcified neoatherosclerosis (cNA) as the cause of ISR. Patients with cNA showed certain characteristics including being older, having worse low-density lipoprotein control and having received less frequent treatment with statins and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), compared with patients with other patterns of ISR. The main substrate of restenosis was underlying cNA, as seen in one-sixth of study populace. Factors independently related to the presence of cNA were time from stent implantation to ISR and absence of treatment with statins or ACEi/ARB. This unique underlying substrate was related to poorer acute outcomes post- reintervention.