Hangover after Side Branch Stenting: the Discomfort Comes Afterwards

The authors report on a patient with recurrent angina at rest and on exertion 2 years after percutaneous revascularisation of the first diagonal branch (D1). Invasive coronary angiography with full functional testing was planned with the tentative diagnosis of coronary vascular dysfunction. Coronary angiography with functional testing revealed a haemodynamically significant intermediate stenosis at the D1-left anterior descending artery bifurcation. Optical coherence tomography demonstrated neointimal bridging and accelerated downstream atherosclerosis that was induced by protrusion of the previously implanted stent into the main branch. Although the overhanging stent was considered insignificant at first, it caused significant discomfort after 2 years. After provisional stenting of the main branch with crushing of the protruding stent and continuous medical treatment, the patient remained free of recurrent angina.