Silent In-Stent Thrombosis Diagnosed by Optical Coherence Tomography and Histopathology of Directional Coronary Atherectomy Specimen.

A 75-year-old woman who underwent percutaneous coronary intervention using an everolimus-eluting stent showed silent in-stent occlusion. Pathological examination of the neointima, resected through directional coronary atherectomy, revealed a double-layered neointima with neointimal hyperplasia and thrombus. Stent-edge restenosis and subsequent thrombosis, related to clopidogrel resistance, likely caused the in-stent thrombotic occlusion.