Case sharing

This case describes a 73-year-old female with recurrent chest pain and a history of coronary stent implantation who presented with acute coronary syndrome. Coronary angiography revealed significant in-stent restenosis in the LAD. Optical Coherence Tomography (OCT) played a crucial role by identifying homogeneous fibrous plaque as the cause of restenosis and providing precise lumen measurements. Based on OCT findings, the treatment strategy shifted to a drug-coated balloon, which achieved a favorable outcome with improved flow reserve and reduced stenosis. Thus, OCT not only clarified the mechanism of restenosis but also guided optimal interventional strategy selection.