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Abstract
<p class="first" id="d4600650e127">A 69-year-old man underwent repeat percutaneous
coronary intervention for in-stent
restenosis in the obtuse marginal artery 8 months after biolimus-eluting stent (2.5 × 28 mm
Nobori stent, Terumo, Tokyo, Japan) implantation. Coronary angiography showed focal
stenosis in the distal part of the stent. Intravascular ultrasound revealed low echoic
heterogeneous intimal tissue. Optical coherence tomography also revealed a heterogeneous
finding classified as a layered pattern. Coronary angioscopy detected a white mass
with a paste-like appearance at the stenosis extending around the in-stent restenosis
as a thin membrane where stent strut could be seen transparently. A small part of
the mass was swinging in the blood stream. Coronary angioscopic imaging was beneficial
for the understanding of the suspected mechanism and feature of the in-stent restenosis
after second-generation stent implantation, which was apparently different from neointimal
hyperplasia after bare-metal stent implantation.
</p><p id="d4600650e129"><
<b>Learning objective:</b> The learning objectives of this case report include understanding
the mechanism of
in-stent restenosis after second-generation drug-eluting stent implantation by showing
the coronary angioscopic imaging beyond the other intravascular imaging. In particular,
this case can make the general and interventional cardiologists learn that the mechanism
of in-stent restenosis <1 year is different from that after bare-metal stent implantation.>
</p>