In-stent restenosis (ISR) is usually detectable in bare metal stents 6 to 9 months after deployment, and this time course correlates in most cases with the peak of neointimal hyperplasia, making this time period the one traditionally used as an arbitrary point for assessment of DES restenosis. The development of late ISR remains an unresolved issue. Several reports exist demonstrating severe late ISR in DES who had undergone a reassuring follow-up angiogram post intervention. We describe one patient who presented with late ISR and crescendo angina pectoris over a 3 week period 36 months after sirolimus stent implantation to his LAD. The ISR was successfully treated with atherectomy and balloon angioplasty. We believe this is the first report to demonstrate ISR in a DES at such a time point.
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