Artigo Acesso aberto Revisado por pares

Clinical Case 20—Recurrent intracoronary in-stent restenosis in a young woman

2022; Oxford University Press; Volume: 118; Issue: Supplement_2 Linguagem: Inglês

10.1093/cvr/cvac157.137

ISSN

1755-3245

Autores

Margarida Cabral, Mariana Carvalho, Sara Lopes Fernandes, Rita Carvalho, Tiago Teixeira, Catarina Ruivo, Pedro Jerónimo Sousa, Alexandre Antunes, João Morais,

Tópico(s)

Cardiomyopathy and Myosin Studies

Resumo

Abstract Clinical case A 39-year-old smoker woman underwent a percutaneous coronary intervention with two Zotarolimus-eluting stents implantation due to right coronary artery occlusion in the context of ST-elevation myocardial infarction (MI). She was medicated with dual antiplatelet therapy and high-intensity statin and stopped smoking. Nine months later, due to angina symptoms, cardiac catheterization with intravascular ultrasound showed severe restenosis, treated with a drug-coated balloon (DCB). Two months later, she was admitted due to non-ST elevation MI and the cardiac catheterization presented thrombotic occlusion of previously implanted stents, treated with balloon dilatation. After two months, she remained with angina and a dobutamine stress echocardiogram showed inferior wall ischemia. The angiographic revision revealed proximal in-stent restenosis, treated with DCB. About a year later, a fifth coronary angiography was performed due to recurrence of angina. Diffuse in-stent restenosis by neo-atherosclerosis was identified by optical coherence tomography. The lesion was treated with a cutting balloon and Everolimus-eluting stent implantation. The cholesterol-lowering treatment was optimized and the patient remained stable for some months. However, she is currently reporting recurrence of angina. Clinical management and guidance await Heart Team discussion. Learning points

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