Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report
Abstract Background Even in the era of new-generation drug-eluting stents, in-stent restenosis remains a common and challenging problem of percutaneous coronary intervention. Among the many factors that contribute to in-stent restenosis, stent-related hypersensitivity is relatively rare, but may be...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-03-01
|
| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-025-05122-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850252033891762176 |
|---|---|
| author | Menghuai Ma Jiong Tang |
| author_facet | Menghuai Ma Jiong Tang |
| author_sort | Menghuai Ma |
| collection | DOAJ |
| description | Abstract Background Even in the era of new-generation drug-eluting stents, in-stent restenosis remains a common and challenging problem of percutaneous coronary intervention. Among the many factors that contribute to in-stent restenosis, stent-related hypersensitivity is relatively rare, but may be a significant trigger of chronic refractory in-stent restenosis. Nevertheless, it is difficult to diagnose and assess the stent-related hypersensitivity, and there is no standardized treatment strategy. Case presentation We present the case of a 63-year-old Chinese female who experienced refractory in-stent restenosis following the successful implantation of platinum chromium everolimus-eluting stents in the left main, left anterior descending and left circumflex artery. Although the cardiovascular risk factors were well-controlled, the patient developed four episodes of acute myocardial infarction with in-stent restenosis within 1 year. Intravascular ultrasound revealed diffuse neointimal hyperplasia in the in-stent restenosis lesion, and the blood tests showed no sign of systemic inflammation or infection. Thus, we speculated that the cause of refractory in-stent restenosis was stent-mediated hypersensitivity. Initially, the in-stent restenosis was treated with paclitaxel-coated balloon angioplasty, and only mild neointimal hyperplasia was observed on intravascular ultrasound 3 months after paclitaxel-coated balloon angioplasty. However, the paclitaxel-coated balloon could not prevent in-stent restenosis recurrence, and she eventually underwent coronary artery bypass grafting. After over 2 years of follow-up, her cardiac function had significantly improved, and the bridging vessels remained patent, as confirmed by computed tomography angiography. Conclusion When encountering refractory in-stent restenosis, physicians should consider the potential for stent-associated hypersensitivity. Since there may be difficulty in obtaining histopathological examination of restenotic vessels, intravascular imaging can be instrumental in detecting neointimal hyperplasia and diagnosing stent allergy. Coronary artery bypass grafting may be a reasonable treatment for patients with stent allergy; further clinical research is required to explore the optimal treatments. |
| format | Article |
| id | doaj-art-16e96ce9fcf940dbb73c2e057cd741fb |
| institution | OA Journals |
| issn | 1752-1947 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj-art-16e96ce9fcf940dbb73c2e057cd741fb2025-08-20T01:57:45ZengBMCJournal of Medical Case Reports1752-19472025-03-011911710.1186/s13256-025-05122-4Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case reportMenghuai Ma0Jiong Tang1Department of Cardiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical UniversityDepartment of Cardiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical UniversityAbstract Background Even in the era of new-generation drug-eluting stents, in-stent restenosis remains a common and challenging problem of percutaneous coronary intervention. Among the many factors that contribute to in-stent restenosis, stent-related hypersensitivity is relatively rare, but may be a significant trigger of chronic refractory in-stent restenosis. Nevertheless, it is difficult to diagnose and assess the stent-related hypersensitivity, and there is no standardized treatment strategy. Case presentation We present the case of a 63-year-old Chinese female who experienced refractory in-stent restenosis following the successful implantation of platinum chromium everolimus-eluting stents in the left main, left anterior descending and left circumflex artery. Although the cardiovascular risk factors were well-controlled, the patient developed four episodes of acute myocardial infarction with in-stent restenosis within 1 year. Intravascular ultrasound revealed diffuse neointimal hyperplasia in the in-stent restenosis lesion, and the blood tests showed no sign of systemic inflammation or infection. Thus, we speculated that the cause of refractory in-stent restenosis was stent-mediated hypersensitivity. Initially, the in-stent restenosis was treated with paclitaxel-coated balloon angioplasty, and only mild neointimal hyperplasia was observed on intravascular ultrasound 3 months after paclitaxel-coated balloon angioplasty. However, the paclitaxel-coated balloon could not prevent in-stent restenosis recurrence, and she eventually underwent coronary artery bypass grafting. After over 2 years of follow-up, her cardiac function had significantly improved, and the bridging vessels remained patent, as confirmed by computed tomography angiography. Conclusion When encountering refractory in-stent restenosis, physicians should consider the potential for stent-associated hypersensitivity. Since there may be difficulty in obtaining histopathological examination of restenotic vessels, intravascular imaging can be instrumental in detecting neointimal hyperplasia and diagnosing stent allergy. Coronary artery bypass grafting may be a reasonable treatment for patients with stent allergy; further clinical research is required to explore the optimal treatments.https://doi.org/10.1186/s13256-025-05122-4Hypersensitivity reactionRefractory in-stent restenosisAcute myocardial infarctionPaclitaxel-coated balloon angioplastyCoronary artery bypass grafting |
| spellingShingle | Menghuai Ma Jiong Tang Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report Journal of Medical Case Reports Hypersensitivity reaction Refractory in-stent restenosis Acute myocardial infarction Paclitaxel-coated balloon angioplasty Coronary artery bypass grafting |
| title | Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report |
| title_full | Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report |
| title_fullStr | Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report |
| title_full_unstemmed | Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report |
| title_short | Stent-induced hypersensitivity leading to refractory in-stent restenosis: a case report |
| title_sort | stent induced hypersensitivity leading to refractory in stent restenosis a case report |
| topic | Hypersensitivity reaction Refractory in-stent restenosis Acute myocardial infarction Paclitaxel-coated balloon angioplasty Coronary artery bypass grafting |
| url | https://doi.org/10.1186/s13256-025-05122-4 |
| work_keys_str_mv | AT menghuaima stentinducedhypersensitivityleadingtorefractoryinstentrestenosisacasereport AT jiongtang stentinducedhypersensitivityleadingtorefractoryinstentrestenosisacasereport |