In this issue of Cardiovascular Revascularization Medicine , Megaly et al. report their single-center experience with vascular brachytherapy (VBT) for recurrent in-stent restenosis (ISR) comparing patients treated with combined VBT and excimer laser coronary atherectomy (ELCA) versus VBT alone. In this difficult-to-treat population, the investigators found comparable outcomes between the two cohorts [ ]. This study adds to the available data in this complex population and supports that both strategies are safe in a real-world high-risk population.