In-stent restenosis following third-generation sirolimus-eluting stent implantation: first report analysed from imaging modalities and histopathological findings
A 63-year-old man was hospitalized due to unstable angina and was subsequently implanted with a 4.0 × 28 mm third-generation sirolimus-eluting stent (SES) in the proximal left anterior descending artery ( Panels A and B ). Twelve months after implantation, he developed chest pain and underwent coronary angiography which revealed in-stent restenosis (ISR) ( Panels C – E ). Percutaneous coronary intervention was therefore performed. The ISR lesion showed iso and low echoic plaque on intravascular ultrasound (IVUS) ( Panel F ) and a layered pattern on optical coherence tomography (OCT) ( Panel G ). The lesion was resected using a novel directional coronary atherectomy (DCA) catheter (.