Sent restenosis – a real problem with multidisciplinary approach

Introduction: Stent thrombosis and stent restenosis are associated with increased morbidity and mortality in patients with coronary stents. The rate of stent restenosis depends on the complexity of coronary lesions. In simple lesions, the rate of stent thrombosis is less than 5% in the first year. Ticagrelor prevents stent thrombosis better than clopidogrel.
Case presentation: We will present the case of a 47 years old female patient, overweight, diabetic (under oral medication), with dyslipidemia and arterial hyper-tension, which was admitted for exertional chest pain. At admission, BP was 170/85 mmHg, HR 74 bpm, BMI 26 kg/m2. Biologically, we identified mixed hyperli-pidemia (cholesterol 233 mg/dl, LDL 145 mg/dl, triglycerides 224 mg/dl), hyperglycemia (fasting blood glucose 153-270 mg/dl, HbA1c 7,9%). The electrocar-diogram showed ischemic changes in the inferior leads. The echocardiography revealed left ventricular hyper-trophy, with normal ejection fraction – EF 60%, witho-ut regional wall motion abnormalities.
In spite of optimal medical therapy, the symptoms prevailed. We performed coronary angiography, whi-ch revealed a 99% lesion at the level of proximal left anterior descending artery. A drug eluting stent was implanted. The patient received dual antiplatelet therapy with aspirin and clopidogrel. After 9 months, the patient presented with aggravated angina. The electrocardiogram showed no changes; the echocardiography identified interventricular septum hypokinesis and preserved ejection fraction. The coronary angiography showed stent restenosis, with no other lesions. We decided to perform balloon angioplasty. Clopidogrel was replaced with ticagrelor and insulin therapy was initiated. Subsequently, the patient remained asymptomatic. The particularity of this case consists in the restenosis of a drug eluting stent, in a young and compliant patient, with multiple cardiovascular risk factors. Assessment and improvement of cardiovascular risk factors are of great significance in coronary patients. Consequently, we decided to switch to ticagrelor and insulin therapy.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)