A 75-year-old man with angina on hemodialysis underwent rotational atherectomy and drug-eluting stent (DES) placement (Resolute Onyx; Medtronic, Minneapolis, Minnesota) in his heavily calcified right coronary artery. Eleven months later, he showed severe in-stent restenosis (ISR) (1st ISR). Intravascular ultrasound (IVUS) exhibited heavily calcified neointima, and an additional DES (Synergy; Boston Scientific, Marlborough, Massachusetts) was implanted (Fig. 1A ). He suffered a 2nd ISR only 1 month later, and optical coherence tomography (OCT) showed protruding neointima with remarkable attenuation (yellow asterisks in Fig. 1B) that obscured the underlying stent struts, suggestive of in-stent calcified nodule, which was successfully treated with drug-coated balloon (DCB) (SeQuent Please; Braun, Melsungen, Germany) (Fig. 1B).
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Published online: July 24, 2021
Accepted: July 12, 2021
Received: June 15, 2021
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