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Repeated In-Stent Restenosis Despite Aggressive Lipid Loweringby PCSK-9 Inhibitor Treatment: A Case Report

Yutaka Yonezawa1, Masashi Sakuma1, Shichiro Abe1

  • 1Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine.

The Tohoku Journal of Experimental Medicine
|October 14, 2021
PubMed

Insights

High-dose statin therapy effectively prevented in-stent restenosis in a patient with coronary artery disease. Intensive statin treatment is recommended over PCSK9 inhibitors for secondary prevention.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Coronary artery disease (CAD) management often involves stent implantation and lipid-lowering therapy.
  • In-stent restenosis (ISR) remains a significant complication post-stenting, necessitating effective prevention strategies.

Observation:

  • A 76-year-old woman developed recurrent ISR despite initial rosuvastatin and PCSK9 inhibitor treatment.
  • Low-density lipoprotein cholesterol levels were significantly reduced but ISR persisted.

Findings:

  • Increasing rosuvastatin to the maximum dose (20 mg/day) successfully prevented further ISR.
  • Intensive statin therapy, not PCSK9 inhibitors, proved effective in this case.

Implications:

  • Maximum-dose statin therapy should be prioritized for secondary prevention of CAD and ISR.
  • This suggests a potential re-evaluation of treatment algorithms prioritizing high-intensity statins.
  • Further research is warranted to compare the efficacy of intensive statin therapy versus PCSK9 inhibitors in preventing ISR.

Keywords:
in-stent restenosislow-density lipoprotein cholesterolproprotein convertase subtilisin/kexin type 9 inhibitorsstatin

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