Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

In-stent neoatherosclerosis (NA) has been reported after drug-eluting stent (DES) and bare-metal stent implantation.1 NA is not only more frequent but also occurs earlier in patients undergoing DES implantation compared with those treated with bare-metal stents.1 This phenomenon has major potential implications because complicated NA (mainly from rupture of a thin-cap fibroatheroma) may result in very late stent thrombosis.2 Although NA can be visualized using intravascular ultrasound (IVUS), optical coherence tomography (OCT), because of its unique resolution (15 μm), appears ideally suited to detect this phenomenon in vivo.2 We report on a patient treated with a drug-coated balloon (DCB) for recurrent in-stent restenosis (ISR) who at late follow-up developed NA as depicted by OCT and IVUS.A 52-year-old man required a paclitaxel-eluting stent implantation on the proximal left anterior descending coronary artery 2 years ago for unstable angina. Ten months later, an everolimus-eluting stent was implanted for ISR and, eventually, 4 months later surgery was required for recurrent ISR with a …