Markedly different tissue types on optical coherence tomography imaging in a patient with multiple lesion drug-eluting stent in-stent restenosis.

The treatment of in-stent restenosis after drug-eluting stent (DES) implantation remains a major clinical challenge. Optical coherence tomography (OCT) imaging at the time of presentation can provide important information on mechanical factors contributing to stent failure as well as on tissue characteristics of the in-stent neointimal tissue. We report a case of markedly different tissue types-characterized by heterogeneous and homogeneous signal intensity-observed in a patient with multiple lesion DES in-stent restenosis. Although both lesions were initially successfully treated with drug-coated balloon angioplasty, the patient presented with recurrent in-stent restenosis in the lesion with homogeneous tissue characteristics. Future studies should evaluate whether OCT tissue characterization can guide optimal treatment strategy in patients with DES restenosis.