In-stent distal circumflex (CX) occlusion

This is a 62-years old man, who presented with mild chest pain, three years following a distal CX stent.

The CT shows in-stent occlusion with no evidence of contrast (Figs. 1,2) within (blue arrows). These images are obtained using a high-resolution algorithm (the B46 on the Siemens scanner). It is necessary to look at the transaxial images (red arrows) to be able to evaluate the lumen properly. The catheter angiogram shows the absence of flow within the stent (Fig. 3).