In-stent intimal hyperplasia peaks in the early phase (6-12 months) after bare-metal stent (BMS) implantation. However, late luminal re-narrowing due to atherosclerotic progression of in-stent intima is reported beyond 4 years. We report the optical coherence tomographic findings of a case of late restenosis of BMS 5 years after implantation. Remarkable in-stent intimal growth was observed, demonstrating a heterogeneous appearance including low-intensity areas and accompanied by intimal rupture. These findings were similar to the morphology of ruptured fibroatheroma in the native coronary artery, and suggested that atherosclerotic change in the in-stent intima occurred over the 5 years following BMS implantation.