Sirolimus-Coated Versus Paclitaxel-Coated Balloon for Recurrent Coronary In-Stent Restenosis After Prior Paclitaxel-Coated Balloon Treatment (SPRIT)

Inclusion Criteria: 1. Age ≥18 years. 2. Stable angina, acute coronary syndrome (NSTEMI at least 7 days after onset or STEMI at least 30 days after onset), prior myocardial infarction, or documented asymptomatic myocardial ischemia. 3. Prior treatment of coronary in-stent restenosis with a paclitaxel-coated balloon alone; recurrent restenosis is in the previously treated segment, including 5 mm beyond the stent edge. 4. Quantitative coronary angiography shows diameter stenosis ≥70%, or ≥50% with evidence of myocardial ischemia. 5. Suitable for either type of coronary revascularization under study. 6. Willing to take aspirin and clopidogrel for 3 months, followed by aspirin monotherapy through study completion. 7. Willing to undergo angiographic and IVUS follow-up at 9 months and clinical follow-up at 30 days and 6, 9, and 12 months. 8. Able to understand the study, provide written informed consent, and comply with study procedures. 9. At least one recurrent target in-stent restenosis lesion requiring intervention, in one target vessel, with no more than two target lesions; any other de novo lesion requiring intervention must be \>10 mm away from a target lesion. 10. Mehran type I, II, or III in-stent restenosis of a bare-metal, inert-coated, or drug-eluting stent; target reference vessel diameter 2.5-4.0 mm and each target-lesion length ≤34 mm. Exclusion Criteria: 1. Takayasu arteritis or active vasculitis. 2. eGFR \<30 mL/min/1.73 m² or dialysis. 3. ALT or AST \>3 times the upper limit of normal. 4. Left ventricular ejection fraction \<30%. 5. Active bleeding, major bleeding within 3 months, or preprocedural hemoglobin \<10 g/dL. 6. Platelets \<100,000/mm³ or INR \>1.5 in the absence of anticoagulation. 7. Cardiogenic shock. 8. Concomitant disease requiring cytotoxic treatment or radiotherapy. 9. Known allergy or contraindication to aspirin, heparin, clopidogrel, sirolimus, ticagrelor, tirofiban, paclitaxel, or iopromide; or contrast allergy not manageable with prophylaxis. 10. Bleeding diathesis or a condition such as gastrointestinal ulcer that limits or prevents required antithrombotic therapy. 11. Pregnancy, planned pregnancy during the study, inability to use effective contraception through the 12-month visit, or breastfeeding. 12. Critical illness or life expectancy ≤1 year. 13. Participation in another interventional study. 14. Investigator judgment that the participant is unsuitable for the study. 15. Three-vessel disease requiring treatment (all three major epicardial vessels with ≥70% stenosis and ischemia) or left main coronary disease. 16. More than three lesions expected to require treatment overall, or more than two lesions requiring treatment in any coronary artery. 17. Target lesion with residual stenosis \>30%, TIMI flow \<3, or type C or worse dissection after predilatation. 18. Target lesion with tortuosity, severe calcification, or angulation expected to prevent passage of the study balloon. 19. Thrombus-containing target lesion. 20. Prior coronary artery bypass grafting.