Naniwa Shota, Tsuda Shigeyasu, Nakazawa Gaku, Yamada Shinichiro
Department of Cardiology, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo 675-1392, Japan.
Department of Cardiology, Kindai University Faculty of Medicine, Sayama, Osaka, Japan.
Eur Heart J Case Rep. 2024 May 14;8(8):ytae233. doi: 10.1093/ehjcr/ytae233. eCollection 2024 Aug.
In-stent restenosis (ISR) remains a significant clinical problem. It is estimated that 10-20% of patients who develop a first event of ISR will develop recurrent ISR (R-ISR). However, the pathology of R-ISR remains largely unknown, and recommendations for its optimal management are lacking. In this case report, we discuss the effectiveness of directional coronary atherectomy (DCA) as an atherectomy device and the mechanism of R-ISR based on pathological findings obtained from DCA.
We report the case of a 62-year-old man with a history of ST-segment elevation myocardial infarction treated with percutaneous coronary intervention (PCI) to the mid left circumflex artery using a bare metal stent. Even after the introduction of adequate secondary prevention therapy for ISR, the patient underwent a total of six PCI sessions over 10 years following primary PCI for R-ISR. Eventually, the decision was made to institute treatment with DCA and a drug-coated balloon. No symptoms of restenosis were observed over the following 4 years.
In this case report, we demonstrate the effectiveness of DCA treatment for debulking a wide range of collagen-rich plaques and show that DCA treatment should be considered for the treatment of R-ISR.
支架内再狭窄（ISR）仍然是一个重大的临床问题。据估计，首次发生ISR事件的患者中有10% - 20%会发生复发性ISR（R - ISR）。然而，R - ISR的病理情况在很大程度上仍不清楚，且缺乏针对其最佳治疗的建议。在本病例报告中，我们基于从定向冠状动脉斑块旋切术（DCA）获得的病理结果，讨论DCA作为一种斑块旋切装置的有效性以及R - ISR的机制。
我们报告一例62岁男性患者，有ST段抬高型心肌梗死病史，曾接受经皮冠状动脉介入治疗（PCI），在左回旋支中段植入裸金属支架。即便在引入针对ISR的充分二级预防治疗后，该患者在首次PCI术后10年内因R - ISR总共接受了6次PCI手术。最终，决定采用DCA和药物涂层球囊进行治疗。在随后的4年里未观察到再狭窄症状。
在本病例报告中，我们展示了DCA治疗对于消除广泛的富含胶原蛋白斑块的有效性，并表明对于R - ISR的治疗应考虑采用DCA治疗。
