Tomberli Benedetta, Fumagalli Stefano, Minopoli Tiziana Cristina, Menale Silvia, Scheggi Valentina, Marchionni Niccolò
Division of Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Eur J Case Rep Intern Med. 2024 Apr 5;11(5):004412. doi: 10.12890/2024_004412. eCollection 2024.
Intracoronary in-stent restenosis (ISR) is a phenomenon that generally occurs between 3 and 6 months after stent placement. With the introduction of drug-eluting stents (DES), the incidence of ISR has decreased but not disappeared. We report a case of reiterant in-stent restenosis of an 81-year-old female patient who underwent multiple percutaneous coronary intervention and two coronary artery bypass surgeries. ISR is possibly associated with extra-stent, stent-related and intra-stent factors. Here, we excluded the first two and focused on the intra-stent factors that seem more likely in our case. A challenging diagnostic workup led us to the hypothesis of a coronary vasculitis potentially triggered by some component of the stent in a predisposed patient carrier of non-disease-specific ANA, with an exaggerated immune response. No recurrence of ISR occurred after the introduction of steroids. Biological and intra-stent causes of ISR should be taken into careful consideration to aim for the early detection of the underlying mechanism of restenosis and to embrace the best therapeutic strategy.
Intra-stent restenosis is possibly associated with extra-stent, stent-related and intra-stent factors.Coronary vasculitis is potentially triggered by some component of the stent in a predisposed patient.Immunosuppressive treatment should be taken into consideration in case of recurrent intra-stent restenosis.
冠状动脉支架内再狭窄（ISR）是一种通常在支架置入后3至6个月出现的现象。随着药物洗脱支架（DES）的引入，ISR的发生率有所下降，但并未消失。我们报告了一例81岁女性患者反复发生支架内再狭窄的病例，该患者接受了多次经皮冠状动脉介入治疗和两次冠状动脉搭桥手术。ISR可能与支架外、支架相关及支架内因素有关。在此，我们排除了前两者，重点关注在我们的病例中似乎更有可能的支架内因素。一项具有挑战性的诊断检查使我们提出假设，即在一名具有非疾病特异性抗核抗体的易感患者中，支架的某些成分可能引发冠状动脉血管炎，并伴有过度的免疫反应。使用类固醇后未再发生ISR。应仔细考虑ISR的生物学和支架内原因，以便早期发现再狭窄的潜在机制并采用最佳治疗策略。
支架内再狭窄可能与支架外、支架相关及支架内因素有关。冠状动脉血管炎可能由支架的某些成分在易感患者中引发。对于反复发生的支架内再狭窄，应考虑免疫抑制治疗。
