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The British Journal
of Cardiology

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Spontaneous resolution of in-stent restenosis

July 2006 Volume 13, Issue 4 Br J Cardiol 2006;13:290-1

Authors:
Sayqa Arif, Jasper Trevelyan, Rajiv Gulati, Peter F Ludman

In 1993, a 61-year-old man underwent balloon angioplasty to the left anterior descending artery (LAD) after an anterior myocardial infarction. Repeat angiography in 1997 after a recurrence of symptoms revealed a severe proximal LAD stenosis, and this was again treated by balloon angioplasty. Two months later, the LAD had occluded and a 16 mm bare stainless steel stent (Nir®) was implanted with a 3 mm balloon (figure 1). Four months afterwards, angiography revealed severe in-stent restenosis (figure 2) and he was referred for coronary artery bypass grafting; the left internal mammary artery (LIMA) was grafted to the LAD.

He remained symptom-free for six years until 2004, when his angina recurred. Repeat coronary angiography demonstrated spontaneous regression of the previously stenosed LAD stent, which was now widely patent (figure 3). The LIMA graft had involuted. A new stenosis in a large obtuse marginal branch was treated with a drug-eluting stent.