Garcia-Guimaraes M, et al. - Researchers examined the prevalence, predictors, and implications of calcified neoatherosclerosis (cNA) as the cause of in-stent restenosis (ISR) in 75 consecutive patients with 81 ISR lesions with a clinical indication for revascularization. These patients were assessed via optical coherence tomography (OCT) before reintervention from January 2014 to August 2016. They detected cNA in older subjects and in those with worse low-density lipoprotein control, and those who received treatment with statins and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) less frequently vs patients with other patterns of ISR. In this group of consecutive patients with clinical ISR, underlying cNA was identified as the predominant substrate of restenosis in one-sixth of them. Associations of this unique underlying substrate with time elapsed from stent implantation and the absence of previous treatment with statins or ACEi/ARB, as well as with poorer acute results after reintervention were observed.