The perioperative management of patients undergoing non-cardiac surgery in the age of increasing percutaneous coronary intervention is a major problem. The present treatment is based on the recommendations of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) [
11,
12]. Additionally, guidelines of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) were published in 2009 [
13].
Patients, receiving a surgical intervention within the first 35 days after coronary stent implantation, have an increased risk of stent thrombosis with consecutively increased morbidity and mortality [
14]. Hence, it is recommended to delay elective interventions about at least 6 weeks (after bare metal stent) [
15] or 12 months (after drug eluting stents) [
16]. If this is no opinion in urgent cases or emergency surgery, an individual, patient adapted strategy has to be carried out. In the present case, the living donor transplantation was called off twice because of an infect exacerbation of the donor, who was now in a good condition. After interdisciplinary discussion the renewed in-stent restenosis was treated by a drug-eluting balloon, followed by anticoagulation with tirofiban and aspirin until surgery. Eptifibatide [
17] or tirofiban [
18] is a possible alternative to clopidogrel. If dual antiplatelet therapy is not possible on account of high bleeding risk, for example in neurosurgery, clopidogrel can be stopped 5–7 days before surgery under current medication with aspirin [
16]. Instead of stenting with BMS or DES a pure balloon angioplasty should be performed under specific circumstances [
16]. These specific circumstances are, however, not specified in the guideline. Thus, preoperative PTCA without stenting seems to be a good “bridging strategy” for patients with intermediate urgency of the planned operation. A recently increasingly used alternative is an intervention with drug eluting balloons [
8‐
10]. Several clinical investigations underline the meaning of drug-eluting balloons in the treatment of instent stenosis [
19‐
21]. This new option may even foster the attitude towards the mentioned “bridging strategy”.