Case Report: A 52-year-old man with arterial hypertension and hypercholesterolemia presented with stable angina pectoris that had lasted for more than 12 weeks. Three years earlier, he had received a bare-metal stent, 3.0 mm in diameter and 18 mm long, to treat a left circumflex lesion. Twenty months before the admission discussed here, he presented with stable angina. The left circumflex bare-metal stent showed no clinically significant in-stent restenosis; however, he received a sirolimus-eluting stent (Cypher, Cordis Corp., Miami Lakes, Florida) of the same dimensions to treat a proximal left anterior descending de novo lesion (Figure 1, part A). Scheduled follow-up coronary angioplasty 7 months later showed no restenosis in the sirolimus-eluting stent (Figure 1, part B). At that time, clopidogrel therapy was discontinued. Thirteen months later, the patient was admitted with stable recurrent angina. His medication consisted of a statin, an angiotensin-converting enzyme inhibitor, a β-blocker, and low-dose aspirin. His total cholesterol level was 4.24 mmol/L (164 mg/dL), and his low-density lipoprotein cholesterol level was 1.97 mmol/L (76.3 mg/dL). Results of electrocardiography performed at rest were normal, but exercise electrocardiography revealed significant ST-segment depression at 100 W. Levels of creatine kinase, creatine kinase-MB, troponin T, and C-reactive protein were within normal ranges. Coronary angiography revealed marked late in-stent restenosis within the sirolimus-eluting stent (Figure 1, parts C and D) 20 months after implantation. In-stent restenosis was treated by percutaneous coronary intervention with no concomitant increase in myocardial markers. Of note, the bare-metal stent located in the left circumflex coronary artery showed no clinically significant restenosis, consistent with the preceding angiographic evaluation 13 months before. The patient's recovery was uneventful.