Tohoku J. Exp. Med., 2021 September, 255(2)

Repeated In-Stent Restenosis Despite Aggressive Lipid Lowering by PCSK-9 Inhibitor Treatment: A Case Report

Yutaka Yonezawa,¹ Masashi Sakuma,¹ Shichiro Abe,¹ Ikuko Shibasaki,² Shigeru Toyoda¹ and Teruo Inoue¹

¹Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
²Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan

A 76-year-old woman with unstable angina underwent coronary stent implantation. At the same time, rosuvastatin therapy was started. However, she experienced repeated in-stent restenosis (ISR). Treatment with a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor along with rosuvastatin (5 mg/day) reduced plasma low-density lipoprotein cholesterol to 10 mg/dL, but failed to prevent further ISR. Eventually, an increase in the rosuvastatin dose to the permitted maximum of 20 mg/day succeeded in preventing further in-stent restenosis. Rather than using PCSK9 inhibitors, intensive statin treatment, using the maximum dose of statins, should be prioritized for the secondary prevention of coronary artery disease.

Keywords —— in-stent restenosis; low-density lipoprotein cholesterol; proprotein convertase subtilisin/kexin type 9 inhibitors; statin

© 2021 Tohoku University Medical Press

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Tohoku J. Exp. Med 2021, 255, 123-126.

Correspondence: Masashi Sakuma, M.D., Ph.D., Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan.

e-mail: masakuma@dokkyomed.ac.jp