The forgotten stent

This is the case of a 78-year-old man with revascularized coronary artery disease 10 years ago (left anterior descending coronary artery and left circumflex artery) who was admitted to the hospital with signs of ST-segment elevation acute coronary syndrome. The angiography shows an unusual image on the proximal left anterior descending coronary artery that seems to be causing an angiographically significant stenosis (figure 1A,B). To confirm diagnosis, a catheter is unsuccessfully advanced with optical coherence tomography (OCT) guidance through a polymeric guidewire while trying to cross the most stenotic region. Two attempts are made after predilatation (with balloons of 1.5 mm and 2.5 mm in diameter) that prove unsuccessful. Afterwards, a guide catheter extension system is advanced (figure 1D) that successfully crosses the lesion facilitating the OCT that reveals the presence of an underexpanded coronary stent with complete endothelization, and a possible thrombus attached to it (figure 1C). Upon suspicion that this is the culprit lesion, decision is made to treat it. To crush the underexpanded stent against the lumen of the vessel, it is first effortlessly predilated using a 3.5 mm x 12 mm balloon. Afterwards, a 3.5 mm x 15 mm drug-eluting stent is implanted with good angiographic...