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Figure 3 This long right coronary artery stenosis (A, arrow) was treated with two overlapping Cypher stents (33 mm and 15 mm in length) with the final result in B. At 7-month follow-up there was focal in-stent restenosis (C, arrow). D (final post-implantation intravascular ultrasound [IVUS]) and E (follow-up IVUS) show identical image slices. At the site of focal intimal hyperplasia (E, white asterisk), the minimum lumen CSA (line of white dots) measured 2.0 mm2, and there was a paucity of stent struts (actually, only 1 stent strut) compared with the same image slice in D. Intimal hyperplasia was very focal and extended for <2 mm proximally and distally. This is an example of focal intra-Cypher stent restenosis, probably from strut fracture (struts were apparent at implantation that were not seen at follow-up).