Optical coherence tomography in differential diagnosis of the morphology of in-stent restenosis and neoaterosclerosis

In spite of widespread use of coronary stents for the treatment of coronary artery disease (CAD), the recurrence of ischemia in the long-term period is still serious limitation of percutaneous coronary interventions. Recurrence of the CAD symptoms in the first year after the intervention is most often due to in-stent restenosis, which is mainly observed after implantation of bare-metal stents. The implantation of a drug-eluting stent effectively suppresses the smooth muscle proliferation underlying the restenosis. Nevertheless, drug-eluting stents can become a site for neoatherosclerosis in the long term due to inflammatory and allergic reactions. Differential diagnosis of these morphological processes using conventional coronary angiography is difficult. Novel methods of intravascular imaging, in particular, optical coherence tomography, provide intravital visualization of pathological processes in stent, which is presented in a current case report.