Very late in-stent restenosis (five years) presenting as an ST elevation acute myocardial infarction.

Late in-stent restenosis is a rare event. The present report discusses the case of a patient who presented with an acute inferior myocardial infarction five years after stent implantation in the distal right coronary artery. Urgent angiography revealed an occluded right coronary artery in the middle portion of the stented segment. The patient underwent uneventful repeat stenting. Late in-stent restenosis may present as an intrastent plaque rupture with a clinical presentation similar to an atherosclerotic plaque rupture.