Sirolimus
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In-stent restenosis due to a hypersensitivity reaction: case report A 64-year-old man developed in-stent restenosis (ISR) due to a hypersensitivity reaction following implantation of sirolimus-eluting [details of drug administration not stated] stents [CYPHER]. The man was admitted with an anterior acute myocardial infarction, and coronary angiography revealed a mid left anterior descending artery (LAD) occlusion. He underwent implantation of three sirolimus-eluting stents for the LAD and left main trunk (LMT). Three weeks later, he underwent implantation of two additional sirolimus-eluting stents for chronic total occlusion of the left circumflex artery (LCx), and a sirolimus-eluting stent for stenosis from the LAD to LMT. Six months later, he developed recurrence of angina pectoris, while coronary angiography revealed a severe stenosis at the distal edge of the stent. He underwent implantation of a further two sirolimus-eluting stents. Two years after initial stent implantation, coronary angiography revealed a focal ISR of the LCx, a diffuse ISR of the LAD, total occlusion of the large diagonal branch, and peri-stent contrast-staining resembling small aneurysms. The man was admitted, and was maintained on aspirin and ticlopidine. He underwent triple coronary bypass surgery with mitral anuloplasty, endarterectomy with removal of three sirolimus-eluting stents, and long on-lay patch anastomosis. Although he had no symptoms consistent with hypersensitivity, histopathology revealed chronic inflammation with a lymphocyte infiltrate, a hypersensitivity reaction with eosinophilia, and subsequent proliferation of smooth muscle cells [outcome not stated]. Author comment: "Here, we report a rare case with a diffuse ISR after CYPHER stent implantation because of chronic inflammation and hypersensitivity reactions". Otsuka Y, et al. Diffuse in-stent restenosis of CYPHER stent due to hypersensitivity reaction confirmed by pathohistological findings. Heart and Vessels 27: 110-113, No. 1, Jan 2012. Available from: URL: http:// 803076162 dx.doi.org/10.1007/s00380-011-0145-1 - Japan
0114-9954/10/1417-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 1 Sep 2012 No. 1417
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