Interv Akut Kardiol. 2003;2(2):89-93

52years old male with in-stent restenosis involving sirolimus eluting stent

Ivo Varvařovský¹, Vladimír Rozsíval¹, Aleš Herman¹, Jan Matějka²

¹ Kardio-Troll, pracoviště invazivní kardiologie, Krajská nemocnice, Pardubice

² Kardiologické oddělení Krajské nemocnice Pardubice

52years old male presented with new onset angina pectoris of the II-III CCS class. We performed coronary angiography and stent primo-implantation due to single vessel disease (proximal LAD). In-stent restenosis (ISR) was detected 10 weeks after the initial procedure and required repeated balloon angioplasty. Recurrence of angina and diffuse in-stent restenosis was detected at the 9-week follow-up after previous intervention, sirolimus eluting stent (SES) was implanted to treat the lesion. The patient underwent a follow-up coronary angiography 3 months after the SES implantation with signs of mild in-stent restenosis; however ischemic symptoms appeared in 3 months and a repeated coronary angiography was required. Critical stenosis involving the proximal part of SES, distal part of left main coronary artery, ostial parts of left anterior descending and left circumflex artery was detected and early surgical myocardial revascularization was recommended.

Sirolimus eluting stent implantation is possibly an effective method of intervention in case of in-stent restenosis. Nevertheless, according to the above-mentioned case and a brief review of available literature, this method has its limitations. SES implantation for ISR (in contrast to de novo lesions intervention) cannot nearly provide elimination of neointimal hyperplasia, restenosis and resulting clinical sequellae.

Keywords: stents, drugs, restenosis.

Published: December 31, 2003  Show citation