A case of coronary artery disease with rapid progress triggered by stent implantation

Drug-eluting stents (DESs) have a low prevalence of in-stent restenosis. However, we describe a patient with coronary artery disease with rapid progress, which might have been triggered by implantation of a DES. The patient was a 72-year-old woman who was first admitted to hospital with non-ST-segment elevated myocardial infarction and had a DES implanted after coronary angiography showed severe stenosis of the left circumflex artery. However, although she kept taking dual antiplatelet therapy, her condition deteriorated and she was admitted to hospital three more times. Angiography showed that the coronary stenosis had become more severe and was more severe not just in the stent-implanted segments, but also in other coronary arteries. Another DES and drug-eluted balloon were used. However, the stent-implanted and balloon-dilated segments became severely stenosed within 1 month. Tests for auto-immune diseases and allergies were negative. We speculate that the first DES triggered an unknown response of the coronary arteries and led to severe stenosis from the stent-implanted segment to the distal segment and other arteries.