Mr. Lam has a history of hypertension and type 2 diabetes, and previously suffered a stroke. He had a stent placed in 2011. 11 years later, he experienced restenosis both inside and outside the stent, prompting doctors to implant an additional stent overlapping the old one to restore blood flow to his heart. The presence of two stent layers increased the risk of further restenosis. Three years later, Mr. Lam again experienced left chest pain and sought examination at Tam Anh General Hospital Hanoi.

Doctor Nguyen Xuan Duy, from the Cardiology Department, reported that the old stent segment in the right coronary artery was severely narrowed by 90-95%, while other segments also showed diffuse narrowing of 40-80%. In-stent restenosis occurs when a previously stented vessel narrows again, obstructing blood flow to the heart and causing myocardial ischemia. Without timely intervention, this condition risks progressing to a myocardial infarction.

The two overlapping stent layers from previous procedures made the third intervention complex, with a high risk of restenosis. Instead of placing another stent over the existing ones, doctors opted for drug-coated balloon angioplasty. This method effectively prevents restenosis without the need for additional metal scaffolding. Following the intervention, Mr. Lam's chest pain resolved, and he recovered quickly, being discharged after 3 days.

The team performing coronary revascularization for the patient. Photo: Tam Anh General Hospital

According to Doctor Duy, despite advancements in stent technology and materials, in-stent restenosis can still occur, especially in patients with diabetes, hypertension, or dyslipidemia. Potential causes include mechanical factors such as: incomplete stent expansion, insufficient lesion coverage, fracture due to calcified plaque, or the placement of multiple stent layers. Modern intravascular imaging techniques and revascularization methods like drug-coated balloon angioplasty have been shown to help reduce the risk of stent restenosis.

Patients who have undergone stent placement must strictly adhere to antiplatelet and statin medications as prescribed by their doctors. It is crucial to effectively control blood pressure, blood sugar, and blood lipids, avoid smoking, limit alcohol, maintain a healthy weight, and attend regular follow-up appointments.

Ly Nguyen

*Patient's name has been changed