Coronary CT Angiography for In-Stent Restenosis: Diagnosis and Therapeutic Planning

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• A 64-year-old male with a history of myocardial infarction and cardiogenic shock underwent percutaneous coronary intervention (PCI).
• Two everolimus-eluting stents were implanted using V-stenting in the left main coronary artery (LM) to the left anterior descending (LAD) and left circumflex (LCX) arteries.
• The patient remained asymptomatic for 9 months before developing progressive angina.

Observation:

• Coronary angiography revealed stent protrusion into the aortic root.
• Dual-source coronary CT angiography identified severe left main-left anterior descending (LM-LAD) stent underexpansion with critical in-stent restenosis.
• Optical coherence tomography confirmed stent underexpansion and restenosis.

Findings:

• Severe LM-LAD stent underexpansion was the primary finding.
• Critical in-stent restenosis at the proximal third of the LM-LAD stent was confirmed.
• The combination of imaging modalities accurately depicted the severity and mechanism of restenosis.

Implications:

• This case underscores the value of complementary invasive and non-invasive imaging in complex PCI.
• Coronary CT angiography proved highly effective in identifying restenosis mechanisms.
• Accurate diagnosis guided successful PCI in a challenging case.