Management of Intra-Stent Restenosis with an Oversized Stent: A Case Report and Review of Percutaneous Coronary Intervention Strategies

Aims: Percutaneous coronary intervention (PCI) is one of the important management options for intra-stent restenosis (ISR) following PCI. Undersized stents may lead to suboptimal results. Hence, adequate stent size relative to the vessel of the target is crucial. In this case, we have placed an oversized stent inside a smaller stent with ISR and followed up.

Case Presentation: A 48-year-old male came with complaints of exertional angina for 2 months. We proceeded with a coronary angiogram, which revealed ISR in the RCA and a patent stent in the LCX. Initial suboptimal predilatation and the non-availability of a cutting balloon were challenging. RCA stenting was done with a larger sized stent. He is doing well at the 22-month follow-up, asymptomatic, and on regular medications.

Discussion: The drug-eluting stent technology at present offers an effective antiproliferative effect. Hence, the demerit of vessel injury was counterbalanced by the merits of bigger final stent dimensions due to oversized stents. Similar to our case, this positive effect of stent oversizing was documented in procedural as well as clinical outcomes.

Conclusion: Selection of larger-size stents (preferably alternative DES) with appropriate attention to the edge effects can be considered an effective strategy for ISR while also optimizing long-term outcomes. Drug-coated balloons (DCB) may be taken into account for broadened use if they are proven to be non inferior to DES in randomized control trials.