Complex bifurcation left main coronary artery in-stent restenosis diagnosed with dynamic volume 320-slice computed tomography

An increasing number of patients undergo left main stenting as an alternative to coronary artery bypass graft surgery (CABGS). Post procedure surveillance with invasive angiography is common practice to detect in-stent restenosis (ISR) which can result in fatal myocardial infarction and even sudden death. There is currently no consensus as to the role of CT angiography in post procedure surveillance or even in patients who present with non-ischaemic sounding chest pain. In this case report we demonstrate the utility of dynamic volume 320-slice computed tomography (CT) in the detection of significant ISR four months after complex bifurcation stenting of the left main artery in a patient presenting with atypical chest pain.