{
  "abstract": "Background: Recurrent in-stent restenosis (ISR) refractory to repeated percutaneous interventions remains a formidable clinical challenge. Despite the established efficacy of drug-coated balloons (DCBs) and drug-eluting stents, a subset of patients experience relentless restenosis, highlighting the need for novel systemic strategies targeting underlying pathophysiological drivers.\n\nObjectives: To describe a case of extreme, refractory recurrent ISR that failed multiple DCB interventions but was associated with a marked response to systemic therapy with Hydroxychloroquine (HCQ) and Sirolimus, and to discuss the mechanistic rationale and potential clinical implications.\n\nMethods: A 56-year-old female presented with rapidly recurring ISR in both the left anterior descending (LAD) and right coronary arteries (RCA). Over a 6-year period, she underwent 11 interventional procedures at our center and at outside institutions. Sequential trials of oral anti-inflammatory agents failed to halt the restenosis cycle. In May 2023, HCQ was initiated, and Sirolimus was added in October 2023. Serial angiographic and intravascular ultrasound (IVUS) follow-up were performed.\n\nResults: Prior to systemic therapy, restenosis occurred every 6 months in both vessels. After initiating HCQ and Sirolimus, the RCA remained free of restenosis for over one year. The LAD, while requiring additional focal DCB treatments, showed a marked reduction in restenosis burden, with disease becoming highly localized. IVUS revealed neointimal hyperplasia with superimposed lipid-rich and fibrous plaques, without evidence of stent fracture or malapposition.\n\nConclusions: In a patient with recurrent ISR, targeted systemic immunomodulation with HCQ and Sirolimus was associated with sustained vessel patency and reduced restenosis burden. This case provides a hypothesis-generating observation that addressing systemic inflammatory and proliferative drivers may repersent a potential salvage strategy for refractory recurrent ISR, warranting further prospective investigation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital",
    "Graduate School, Beijing University of Chinese Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jiangquan Liao"
    },
    {
      "affs": [
        0
      ],
      "name": "Yan Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jie Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Tianshu Xie"
    },
    {
      "affs": [
        0
      ],
      "name": "Peng Yang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lin Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Tong Gao"
    },
    {
      "affs": [
        0
      ],
      "name": "Qian Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jiejia Liang"
    },
    {
      "affs": [
        1
      ],
      "name": "Qian Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Weidong Hong"
    },
    {
      "affs": [
        0
      ],
      "name": "Ke Dong"
    },
    {
      "affs": [
        0
      ],
      "name": "Changhong Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Di Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xianlun Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Mingjing Shao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7deksmd456hmb.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1886312",
  "fulltext_url": null,
  "id": "7deksmd456hmb",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1886312/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ]
  ],
  "openalex": "W7224096636",
  "pdf_url": "https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2026.1886312/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/7deksmd456hmb.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1886312",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1886312/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
    }
  ],
  "title": "Case Report: Shifting the paradigm in refractory in-stent restenosis: systemic immunomodulation with hydroxychloroquine and sirolimus",
  "title_text": "Case Report: Shifting the paradigm in refractory in-stent restenosis: systemic immunomodulation with hydroxychloroquine and sirolimus",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/7deksmd456hmb",
  "venue": "Frontiers in Cardiovascular Medicine",
  "versions": []
}