Virtue® SAB in the Treatment of Coronary ISR Trial

Inclusion Criteria:

* In-stent restenosis (one or two stent layers) in a lesion previously treated with drug- eluting (DES) or bare metal stents (BMS) in a native coronary artery.
* The target lesion has a reference vessel diameter ≥ 2.0 mm and ≤ 4.0 mm by visual assessment.
* The subject has only one critical ISR lesion in the target vessel.
* The subject may have one other critical lesion in a non-target vessel that must be treated before the Target Lesion (TL).
* Target lesion length must be ≤ 26 mm and must be completely coverable by only one Virtue® or AGENT™ balloon. The balloon can extend up to 5 mm proximal or distal beyond the edge of the target stented length.
* The target lesion must have one of the following:
* Visually estimated stenosis of ≥ 70% and \<100% diameter stenosis, OR
* Visually estimated stenosis ≥ 50% and \< 70% with one of the following:
* abnormal fractional flow reserve (FFR) including Angio based FFR ≤ 0.80, or;
* abnormal instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) ≤ 0.89, or;
* abnormal stress or imaging stress test, or;
* ischemic symptoms referable to the target lesion
* Involved in a NSTEMI or Acute Coronary Syndrome (ACS) event with decreasing enzymes
* Target lesion must be successfully pre-treated according to standard of care with an achieved residual stenosis of ≤ 30% by visual estimate with TIMI grade flow of 3 prior to randomization.

Exclusion Criteria:

* Subject has a left ventricular ejection fraction \< 30% within 6 months.
* Subject was treated by PCI or another coronary intervention within the last 30 days.
* Planned PCI or CABG after the index procedure.
* Subjects with STEMI \< 72 hours prior to index procedure and those with NSTEMI who have increasing biomarkers within 12 hours of the index procedure.
* If single-layer ISR, any previous treatment (other than balloon angioplasty alone) of the target vessel for restenosis. If double-layer ISR, any treatment (other than balloon angioplasty alone) of the double-layer ISR restenosis.
* Target lesion is located within a saphenous vein graft or an arterial graft.
* Thrombus is present in the target vessel.
* \> 50% stenosis of an additional lesion proximal or clinically significant distal (\>2.0mm RVD) to the target lesion.
* A dissection in the target lesion requiring treatment with a stent post pre-dilatation.
* The target ISR lesion has more than two layers of previously placed stents.
* Subject has critical unprotected left main coronary artery disease.