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A 76-year-old man underwent hybrid stent implantation, involving a bare metal stent (BMS) and a sirolimus-eluting stent (SES) (Picture 1). Follow-up coronary angiography indicated the absence of in-stent restenosis and peri-stent contrast staining (PSS) (Picture 1). After seven years, he presented with unstable chest pain, and coronary angiography indicated the presence of severe stenosis at the proximal edge of the SES, as well as multi focal PSS outside the SES with a “caterpillar-like appearance.” Multiple intravascular imaging modalities demonstrated good neo-intimal coverage at the BMS implantation site. In contrast, incomplete stent apposition and red thrombi were observed between the stent struts within the SES-implanted segment (Picture 2). In the present case, multiple imaging observations re-

Different Vascular Reactions after "Hybrid Stenting"