In-stent restenosis associated with stent malapposition: Seven year optical coherence tomography findings

Stent thrombosis and in-stent restenosis remain significant issues in post-coronary angioplasty care despite advances in anti-platelet therapy and stent technology. Angiographic predictors of stent failure have been proposed, but its precise mechanism has been difficult to elucidate on conventional coronary angiography and intravascular ultrasound due to the low resolution of either approach. Optical coherence tomography (OCT) as a high-resolution intracoronary imaging modality has enabled more detailed insight into the interaction between implanted stent and underlying endothelium, the evolution of unstable plaque, and the pathogenesis of late lumen loss, affirming its place as an essential tool in the modern-day cardiac catheterisation laboratory. We present a case of in-stent restenosis seven years after bare-metal stent insertion, the mechanism of which was gross stent malapposition as clearly demonstrated on OCT examination.