A 63 year-old man visited our hospital because of recurrent chest pain and underwent coronary intervention with Taxus Liberte 3.5x32mm and 4.0x16mm from distal left main and proximal LAD 9 month ago. (Figure 1) After intervention, he did not feel any chest discomfort. However, 9 month follow-up coronary angiogram showed significant stenosis at previous stent site. So, he readmitted for the revascularization. His coronary risk factors were an ex-smoker and hypertension. Thallium spect showed normal perfusion state.

1. A Left coronary angiogram showed significant stenosis at previous drug eluting stent site. ( Movie 1)
2. A Right coronary angiogram showed no significant stenosis. ( Movie 2)

An 8 Fr sheath was inserted through right femoral artery and another 5 Fr sheath was inserted through the left femoral vein. Left coronary artery was engaged with a JL4 SH 8Fr guiding catheter. First, to evaluate proximal ISR lesion, virtual histology (VH) was performed. VH showed mainly fibrotic tissue characteristics at ISR lesion. (Figure 2) Then, an intravascular ultrasound (IVUS) (Boston Scientific) was performed. IVUS showed 2.2 mm² minimal lumen area (MLA) at pLAD ISR site (Figure 3). IVUS and VH demonstrated diffuse fibrotic plaque at previous stent site. After pressure wire (RADI) insertion, we checked FFR. Baseline FFR was 0.97. Then we induced hyperemia by adenosine 140mcg/kg/min infusion via femoral route. After induction of hyperemia, FFR was 0.83. (Figure 4) For that intermediate lesion, we checked another functional study (treadmill test). At treadmill test, he exercised until 13.4 METs without chest pain or ST change. So, instead of performing coronary intervention, we decided to treat medically.