A 62-year-old man was admitted to our hospital because of a non-ST-segment elevation myocardial infarction. Two years earlier, he had undergone percutaneous coronary intervention at another institution; two sirolimus-eluting stents (2.75 mm in diameter) were implanted in the mid-LAD coronary artery. Coronary angiography showed mild disease of the proximal LAD and a bumpy scratchy image in the mid-vessel ( Fig. 1 A and B), resembling a caterpillar ( Fig. 1 C). A lateral view suggested persistence of contrast medium appearing as little lumps behind the stent structure during the run-off phase ( Fig. 2 A and B). IVUS revealed a large vessel and incomplete stent strut apposition to the arterial wall ( Fig. 3 ). Also, the IVUS pullback sequence showed contrast lucent echoes flushing from the vessel lumen towards an empty space beneath the stent structure ( Video 1 ). To prevent relapsing events, the patient was discharged on indefinitely prolonged dual antiplatelet therapy with aspirin and clopidogrel.
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