[Repeated percutaneous coronary intervention due to repeated acute coronary syndrome caused by different coronary...

Area of Science:

• Cardiology
• Vascular Medicine
• Interventional Cardiology

Background:

• Acute coronary syndrome (ACS) necessitates timely intervention, often involving percutaneous coronary intervention (PCI) with stenting.
• Recurrent ACS after successful stenting raises concerns about in-stent events like thrombosis or restenosis.
• Identifying patients at high risk for recurrent cardiovascular events remains a clinical challenge.

Observation:

• A 74-year-old female experienced two distinct episodes of ACS within six months, requiring coronary stenting on both occasions.
• The first ACS involved the left anterior descending artery, while the second involved the right coronary artery, indicating separate events.
• Both instances of ACS were attributed to single-vessel disease in anatomically distinct coronary arteries.

Findings:

• Coronary artery stenting did not prevent a subsequent, unrelated ACS event, suggesting persistent plaque vulnerability.
• The recurrent ACS was caused by de novo stenosis in a different coronary artery, not an in-stent complication.
• This case underscores that ACS can manifest due to new atherosclerotic lesions in previously unaffected coronary arteries.

Implications:

• Patient vulnerability to ACS may persist even after successful stenting and guideline-directed medical therapy.
• The diagnostic approach for recurrent ACS should consider new atherosclerotic events beyond in-stent issues.
• Enhanced surveillance and risk stratification strategies are essential for patients with a history of ACS and stenting.