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Published on: May 14, 2013
Early Restenosis of Sirolimus-eluting Stent: An Unusual Case of a Hyperthyroid Patient
Syeda Javeria Shabbir1, Mariam Baloch2, Faryal Mustafa1
1Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Insights
Hyperthyroidism and multinodular goiter may increase the risk of in-stent restenosis after drug-eluting stent placement. This case highlights a potential link between goiter and cardiovascular complications, warranting further investigation.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Hyperthyroidism is linked to increased cardiovascular risks, including hypertension and atrial fibrillation.
- Drug-eluting stents (DES) are effective in reducing short-term in-stent restenosis (ISR).
- Limited data exists on the association between multinodular goiter (MNG) and ISR, particularly in Pakistan.
Observation:
- A 57-year-old hyperthyroid female with massive MNG presented with worsening chest pain.
- She had previously undergone sirolimus-eluting stent (SES) implantation in the left anterior descending artery (LAD).
- Cardiac catheterization revealed restenosis of the SES in the LAD, with occlusions in other coronary arteries.
Findings:
- The patient exhibited restenosis of the sirolimus-eluting stent (SES) in the left anterior descending artery (LAD).
- Coronary angiography also showed occlusions in the left circumflex and right coronary arteries.
- Echocardiography indicated grade I diastolic dysfunction and mild aortic regurgitation.
Implications:
- This case suggests a potential correlation between multinodular goiter (MNG) and in-stent restenosis (ISR) in hyperthyroid patients.
- Further research is needed to explore the association between MNG and cardiovascular complications, especially ISR.
- Understanding this link could lead to improved risk stratification and management strategies for patients with MNG and atherosclerosis.
Abstract:
The presentation of atherosclerosis with concomitant hyperthyroidism is not uncommon. Hyperthyroidism predisposes to worse cardiovascular pathologies like systolic hypertension, atrial fibrillation, and hypercoagulability. Drug-eluting stents, on the other hand, have emerged as a miracle treatment choice for patients having atherogenic conditions. They have the highest success rates when it comes to minimizing in-stent restenosis (ISR) during short-term follow-up. There is scarce literature that assesses the correlation of multinodular goiter (MNG) to ISR, especially in Pakistan, and thus any probable association between the two is left untouched. We report a case of a 57-year-old female who is a known hyperthyroid with a massive MNG, presenting with worsening chest pain. She had undergone sirolimus-eluting stent (SES) implantation in left anterior descending artery (LAD) six months back. Cardiac catheterization confirmed restenosis of the SES in the LAD, along with the occlusion of left circumflex and right coronary artery, accompanied by grade I diastolic dysfunction and mild aortic regurgitation on echocardiography.
