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Peer-reviewedCC BY-NC-NDBMC cardiovascular disorders

Refractory rapidly progressive diffuse in-stent restenosis with left main involvement: a case report.

  • Xiaoyan Wang1
  • Haichao Yang2
  • Liqiang Qin2
  • Wei Lu2
  • Lijun Wang2
  • Jianjun Wang2
  • Juan Li2
  • Kaibin Deng2
  • Chenguang Gao2
  1. 1Department of Cardiology, The Third Hospital of Shijiazhuang, 15 Tiyu South Street, Shijiazhuang, Hebei Province, 050011, China. [email protected].
  2. 2Department of Cardiology, The Third Hospital of Shijiazhuang, 15 Tiyu South Street, Shijiazhuang, Hebei Province, 050011, China.
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Abstract

Background

Drug-eluting stents (DES) have significantly reduced the incidence of in-stent restenosis (ISR). However, a subset of patients still develop refractory, rapidly progressive, and diffuse ISR, which poses substantial therapeutic challenges and reflects its complex underlying mechanisms.Case presentation

We report a 46-year-old male who underwent five percutaneous coronary interventions (PCI) over five years, with repeated diffuse ISR in the left anterior descending artery (LAD). Initial PCI was followed by DCB therapy after first ISR, achieving temporary symptom relief. Four years later, ISR progressed to chronic total occlusion, requiring further stenting and DCB therapy. Within five months, he developed 99% LM stenosis and recurrent LAD ISR. Despite a SYNTAX score of 36 favoring CABG, the patient refused surgery. Under intra-aortic balloon pump support, a balloon-only PCI (stent-less) strategy was performed. IVUS revealed diffuse fibrous proliferation and neoatherosclerosis. During follow-up, the patient remained clinically stable overall.Conclusion

This case highlights a potential systemic hyperproliferative phenotype, in which repeated vascular injury triggers accelerated neoatherosclerosis and intimal hyperplasia. It challenges the conventional view of ISR as a local mechanical problem and underscores the importance of mechanism-driven risk stratification and individualized management, particularly when standard surgical therapy is declined.

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Cite

BibTeXRIS
BibTeX
@article{wang2026refractory,
  title = {{Refractory rapidly progressive diffuse in-stent restenosis with left main involvement: a case report.}},
  author = {Xiaoyan Wang and Haichao Yang and Liqiang Qin and Wei Lu and Lijun Wang and Jianjun Wang and Juan Li and Kaibin Deng and Chenguang Gao},
  journal = {BMC cardiovascular disorders},
  year = {2026},
  month = jul,
  doi = {10.1186/s12872-026-06343-1},
  url = {https://europepmc.org/article/MED/42902154},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Refractory rapidly progressive diffuse in-stent restenosis with left main involvement: a case report.
AU  - Xiaoyan Wang
AU  - Haichao Yang
AU  - Liqiang Qin
AU  - Wei Lu
AU  - Lijun Wang
AU  - Jianjun Wang
AU  - Juan Li
AU  - Kaibin Deng
AU  - Chenguang Gao
PY  - 2026
DA  - 2026/07/01
JO  - BMC cardiovascular disorders
DO  - 10.1186/s12872-026-06343-1
UR  - https://europepmc.org/article/MED/42902154
AB  - Background  Drug-eluting stents (DES) have significantly reduced the incidence of in-stent restenosis (ISR). However, a subset of patients still develop refractory, rapidly progressive, and diffuse ISR, which poses substantial therapeutic challenges and reflects its complex underlying mechanisms.Case presentation  We report a 46-year-old male who underwent five percutaneous coronary interventions (PCI) over five years, with repeated diffuse ISR in the left anterior descending artery (LAD). Initial PCI was followed by DCB therapy after first ISR, achieving temporary symptom relief. Four years later, ISR progressed to chronic total occlusion, requiring further stenting and DCB therapy. Within five months, he developed 99% LM stenosis and recurrent LAD ISR. Despite a SYNTAX score of 36 favoring CABG, the patient refused surgery. Under intra-aortic balloon pump support, a balloon-only PCI (stent-less) strategy was performed. IVUS revealed diffuse fibrous proliferation and neoatherosclerosis. During follow-up, the patient remained clinically stable overall.Conclusion  This case highlights a potential systemic hyperproliferative phenotype, in which repeated vascular injury triggers accelerated neoatherosclerosis and intimal hyperplasia. It challenges the conventional view of ISR as a local mechanical problem and underscores the importance of mechanism-driven risk stratification and individualized management, particularly when standard surgical therapy is declined.
SN  - 1471-2261
ER  -