Very Late Restenosis after Paclitaxel-Eluting Stent Implantation

Background: Late restenosis after drug-eluting stent implantation has been described for sirolimus-eluting stents (Cypher, Johnson & Johnson, Warren, New Jersey) (1–3) but not for paclitaxel-eluting stents (Taxus, Boston Scientific, Natick, Massachusetts) (4).

Objective: To describe a patient with a paclitaxel-eluting stent who presented with late in-stent restenosis 33 months after stent placement.

Case Report: A 76-year-old man with a history of an inferior myocardial infarction and coronary artery bypass grafting in 1989 presented to our center in April 2004 with stable angina pectoris. In 2001, he underwent bare-metal stent implantation in the saphenous vein graft to the right coronary artery, and a covered pericardium stent was placed in the vein graft because of disease progression in September 2003. In April 2004, a 3.5 × 28 mm paclitaxel-eluting stent was implanted at 18 atmospheres under intravascular ultrasonography guidance in the vein graft for focal restenosis within the bare-metal stent (Figure, A and B). Routine follow-up angiography in November 2004 revealed a widely patent stent site in the vein graft (Figure, C). In September 2005, a percutaneous intervention was performed on the proximal left anterior descending coronary artery. The stent site in the vein graft was widely patent, but there was a suggestion of distal disease progression (Figure, D). In April 2006, another paclitaxel-eluting stent was implanted in the vein graft distal to the previously implanted stent (Figure, E). In September 2006, follow-up angiography again revealed a widely patent stent site in the vein graft (Figure, F). The patient presented with stable angina and a positive exercise test in January 2007. Angiography demonstrated focal restenosis of the vein graft in the proximal paclitaxel-eluting stent, which was successfully treated by implantation of a 3.3 × 23 mm sirolimus-eluting stent (Figure, G).