Recurrent intra-stent coronary restenosis in a carrier of non-disease-specific antinuclear antibodies
  • Benedetta Tomberli
    Division of Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Stefano Fumagalli
    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  • Tiziana Cristina Minopoli
    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  • Silvia Menale
    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  • Valentina Scheggi
    Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Niccolò Marchionni
    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

Keywords

Intracoronary in-stent restenosis, coronary vasculitis, autoimmune disease

Abstract

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.

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    Published: 2024-04-05
    Issue: 2024: Vol 11 No 5 (view)


    How to cite:
    1.
    Tomberli B, Fumagalli S, Minopoli TC, Menale S, Scheggi V, Marchionni N. Recurrent intra-stent coronary restenosis in a carrier of non-disease-specific antinuclear antibodies. EJCRIM 2024;11 doi:10.12890/2024_004412.