Diagnosis and treatment evaluation of in-stent restenosis of carotid artery stenting using optical coherence tomography

A 65-year-old man underwent balloon angioplasty and repeat carotid artery stenting (CAS) due to in-stent restenosis (ISR). Intravascular optical coherence tomography (OCT) showed a severe ISR with fibrotic neointimal growth (figure 1). Post 6.0 × 30 mm balloon angioplasty, OCT showed intimal disruption and artery dissection (figure 2). After the 8 × 40 mm stent fully expanded, OCT showed stent struts well apposed, but tissue protrusion from the spaces between stent struts can be observed (figure 2). OCT allowed measurement of intimal hyperplasia after the CAS and observation of intimal disruption and stent strut apposition intraoperatively.1,2