A 68-year-old man was admitted to our hospital with unstable angina. His medical history was remarkable for an acute myocardial infarction one year ago, treated with a zotarolimus-eluting stent (3.5×30 mm) in the mid right coronary artery. Coronary angiography showed a diffused in-stent restenosis (ISR) with haziness and filling defects (Figure 1A, Video 1). In order to identify the underlying mechanisms of ISR, optical coherence tomography (OCT) was performed due to its high resolution. OCT showed a large, recanalized thrombus with multiple channels divided by thin septa (longitudinal view and Figure 1C-1E) in the setting of an undersized stent (Figure 1F compared to Figure 1B, distal reference). Coexistent malapposition, uncovered struts and neoatherosclerosis were also detected (Figure 1D and 1F, Video 2).
2. Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
3. Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China, China
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