Restenosis After Pulmonary Vein Stenting Following Pulmonary Vein Isolation With Nonobstructive General Angioscopy

A 33-year-old male developed pulmonary vein (PV) stenosis 3 months after PV isolation for atrial fibrillation. Stents were implanted in the left superior and inferior PVs, but 2 years later, in-stent restenosis occurred. Intravascular ultrasound and nonobstructive general angioscopy (NOGA) revealed severe ostial stenosis and neointimal hyperplasia. Drug-coated balloon angioplasty was performed, and NOGA confirmed paclitaxel deposition. This case highlights the utility of NOGA for directly visualizing neointimal changes and drug delivery, which are not assessable by intravascular ultrasound alone. This is the first report to demonstrate in-stent restenosis and post-drug-coated balloon changes in the pulmonary vein using NOGA.