Primary or de novo spontaneous coronary dissection has been reported in many cases; however, in-stent dissection was demonstrated in the previously stented segment of coronary artery only in an autopsy study. Therefore, we report a 78-year-old female presenting with angina pectoris and dyspnea for the last 20 days. She had undergone stent implantation for a significant stenosis in the left anterior descending artery 3 years ago. In-stent dissection flap limiting coronary flow was noted at the coronary angiography and successfully treated with coronary restenting. She had no symptoms at follow-up. (C) 2007 Elsevier Ireland Ltd. All rights reserved.