Kim HO, Jung HW, Lee JH, et al. - Since research has demonstrated that the prognosis of in-stent restenosis (ISR) lesions following drug-coated balloon (DCB) angioplasty can vary in relation to in-stent neointimal features, therefore, researchers used the Yonsei Optical Coherence Tomography (OCT) registry to determine alterations in neointima characteristics post-DCB for ISR. Neointima features were grouped as homogeneous, heterogeneous, layered neointima, and neoatherosclerosis in each OCT procedure. Homogeneous appearance on the follow-up OCT was mostly revealed in patients with homogeneous and layered neointima on the initial OCT prior to DCB, whereas most of the patients with heterogeneous neointima on the initial OCT continued to be unchanged (70%). According to findings, the follow-up OCT neointimal features post-DCB for ISR were related to initial OCT features. In patients with ISR managed with DCB, a poor prognosis may be reflected by sustained unfavorable neointima in serial OCT imaging.