The problem of peripheral in-stent restenosis (ISR) remains a major problem for clinicians and there is currently no FDA-cleared or approved device to treat this growing patient population. There are several companies that make atherectomy devices but one company in particular, Spectranetics (Colorado Springs, Colorado), appears to be at the head of the line in terms of building out evidence to support the use of its laser atherectomy catheter to address this problem.