Repeated in-stent occlusion of RCA: a case report

There are few reports of cases with more than 3 in-stent coronary occlusion on the basis of conventional dual antiplatelet therapy. The possible mechanism of repeated in-stent occlusion is a question worthy of consideration. The selection of treatment strategies for recurrent in-stent occlusion is more challenging than that for the initial percutaneous coronary intervention.

A 74-year-old woman with a long history of rheumatoid arthritis underwent percutaneous coronary intervention (implantation of three stents in series) of the right coronary artery due to ST-segment elevation myocardial infarction and received long-term dual antiplatelet therapy. Within the subsequent 9.5 months, in-stent occlusion was detected three times, and she underwent percutaneous coronary intervention each time. After adding colchicine to the treatment, during a six-month follow-up, no adverse cardiovascular events occurred in the patient.

Long stents with tandem configurations are more prone to thrombus formation at coronary turning point of right coronary artery, and re-stenting at this site fails to prevent recurrent stent thromboembolism, which might be related to the pockets under expanded and mal apposed stent segments. For the patients with autoimmune diseases, it remains to be further clarified whether combining low-dose colchicine with dual antiplatelet therapy and statins may offer adjunctive benefit. Guided by intracavitary imaging examinations, interventional treatment for diffuse lesions of the right coronary artery should prioritize avoiding tandem stacking of stents and minimizing stent placement at the vascular turning points.