A 60-year old male was admitted for scheduled follow-up coronary angiography after long Cypher stent implantation for restenotic lesion. At admission, he was free from angina. His coronary risk factor was hypertension.

At seventy month ago, he was presented with unstable angina and underwent bare-metal stent (BX Velocity 3.0 x 23 mm) implantation at the middle LAD. After index procedure, six-month follow-up angiography showed diffuse in-stent restenosis (ISR) at previous stented segment (Image 1, Image 2). Cypher stent (3.0 x 33 mm) was implanted with overlapping (Image 3, Image 4).

After the second procedure, follow-up angiography showed ISR related with stent fracture at the mid portion of the overlapped long stent (Image 5, Image 6). IVUS demonstrated significant neointimal hyperplasia with discontinuity of stent struts (Movie 1). A 6F Judkins guiding catheter was engaged into the left coronary ostium. A 0.014 inch Whisper guidewire was placed into the LAD. The lesion was dilated with a 3.0 x 15 mm conventional balloon up to 12 atm without additional stenting. Final angiogram showed successful procedural result (Image 7).