JACC Case Rep. 2026 Jun 12:108817. doi: 10.1016/j.jaccas.2026.108817. Online ahead of print.
ABSTRACT
BACKGROUND: Coronary involvement in Takayasu arteritis is uncommon but associated with high rates of in-stent restenosis and challenging revascularization.
CASE SUMMARY: A 22-year-old woman with Takayasu arteritis and congenital antithrombin III deficiency presented with non-ST-segment elevation myocardial infarction due to severe ostial right coronary artery in-stent restenosis after multiple prior percutaneous interventions. Intravascular ultrasound confirmed significant neointimal hyperplasia. A stent-sparing strategy using excimer laser coronary atherectomy, cutting balloon angioplasty, and paclitaxel drug-coated balloon under intravascular ultrasound guidance was performed with bivalirudin anticoagulation. Final angiography demonstrated TIMI 3 flow with significant luminal gain.
DISCUSSION: Recurrent restenosis in Takayasu arteritis represents a major therapeutic challenge. This case highlights the role of multimodal, stent-avoidant strategies and individualized anticoagulation in complex inflammatory vasculopathy with concomitant thrombophilia.
TAKE-HOME MESSAGES: Recurrent in-stent restenosis in Takayasu arteritis reflects ongoing vascular inflammation and requires strategies beyond repeat stenting. A stent-sparing, intravascular imaging-guided approach using laser atherectomy and drug-coated balloon can effectively treat refractory restenosis while minimizing additional stent burden.
PMID:42283679 | DOI:10.1016/j.jaccas.2026.108817