Tristi Lukita Wening
Department of Cardiology and Vascular Medicine, RS Jantung Diagram Siloam, Cinere, Depok, Indonesia

Sidhi Laksono Purwowiyoto
Faculty of Medicine of Universitas Muhammadiyah Prof Dr Hamka, Tangerang, Indonesia

DOI: https://doi.org/10.19184/ams.v9i2.38431

Abstract

DES has become the standard of care in clinical practice for patients undergoing Percutaneous Coronary Intervention (PCI). In-Stent Restenosis (ICR) occurs in 2-10% of a certain patient. Polycythemia Vera (PV) occurs when the body produces excessive red blood cells. It is uncommon for PV to manifest as ISR in DES that has been implanted for days. Here we present a case of a patient with PV who developed ISR shortly after PCI. We describe a 63-year-old man with polycythemia vera and an acute STEMI anterior with a history of PCI 13 days before. Coronary angiography revealed stenosis in the LCx and total ISR in LAD. We switched clopidogrel to ticagrelor and kept aspirin to prevent reoccurring ischemia occurrences. It is uncommon for PV to manifest as ISR in DES that have been implanted for days, even though PV and coronary artery disease (CAD) are linked. The treatment goal is to prevent thrombotic events. Patients with a history of PCI procedures have a higher risk of stent thrombosis, so besides Aspirin, another anti- platelet such as ticagrelor, should be used after. We can conclude that ISR in PV patients who underwent a PCI with DES is still a challenging clinical problem. Because of intimal proliferation and blockage brought on by enhanced platelet aggregation and increased shear stress due to elevated hematocrit, the PV makes the circumstances worse.

Keyword: DES; ISR; Polycythemia Vera.

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