In-stent ulceration: an unusual pathology

Area of Science:

• Cardiovascular Medicine
• Neurology
• Interventional Cardiology

Background:

• In-stent restenosis (ISR) is a common complication following interventional therapy, occurring in 10-60% of cases.
• While various mechanisms contribute to ISR, restenosis specifically caused by an ulcerated plaque is exceptionally rare and poorly documented.
• Ulcerated plaques can pose unique challenges in restenosis management.

Purpose of the Study:

• To report a rare case of neurological symptoms secondary to carotid artery in-stent restenosis caused by an ulcerated plaque.
• To elucidate the specific mechanisms involved in this unusual presentation of ISR.
• To discuss the available treatment strategies for complex in-stent restenosis.

Main Methods:

• Case report of a 72-year-old male presenting with neurological deficits.
• Review of diagnostic imaging and interventional procedures.
• Literature review on mechanisms and management of in-stent restenosis, particularly ulcerated plaque-related cases.

Main Results:

• The patient presented with neurological symptoms attributed to severe in-stent restenosis of the carotid artery.
• Diagnostic findings confirmed an ulcerated plaque as the cause of restenosis.
• The case highlights a rare but significant etiology for ISR.

Conclusions:

• In-stent restenosis due to an ulcerated plaque is a rare but critical cause of neurological events.
• Understanding the specific mechanisms is crucial for effective diagnosis and treatment.
• This case underscores the importance of considering diverse etiologies in managing ISR and its complications.