Ruptured plaque in a bare-metal stent 8 years after implantation-Comparison of IVUS and OCT findings.

Optical coherence tomography (OCT) and intravascular ultrasound tomography (IVUS) findings in a patient with very late in-stent restenosis that was manifested as acute coronary syndrome 8 years after bare-metal stent implantation are presented. This case clearly shows the disruption of thin fibrous cap associated with a white thrombus by OCT. A superficial high signal with deep attenuation by OCT, composing more than half of the plaque, was expressed as heterogeneous tissue, mainly composed of echolucent lesion including outside the struts by IVUS. OCT was very useful, like it is for de novo vulnerable plaques, to evaluate vulnerable plaque that had formed in a previously implanted stent. On the other hand, tissue outside the stent struts could be visualized by IVUS. Combined use of OCT and IVUS was useful for understanding the plaque characteristics of ruptured vulnerable plaque that had formed in a previously implanted bare-metal stent even after stabilization of neointimal hyperplasia.