Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 40-45
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.40
Aggressive restenosis after percutaneous intervention in two coronary loci in a patient with human immunodeficiency virus infection
Mohammad Alkhalil, Christopher P Conlon, Houman Ashrafian, Robin P Choudhury
Mohammad Alkhalil, Robin P Choudhury, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
Christopher P Conlon, Department of Infectious Diseases, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
Houman Ashrafian, Department of Cardiology, John Radcliffe, Headington, Oxford OX3 9DU, United Kingdom
Robin P Choudhury, Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
Author contributions: All authors contributed to patient’s management, and the preparation and revision of the manuscript.
Institutional review board statement: This case does not require Institutional Review Board at University of Oxford.
Informed consent statement: The patient has provided verbal consent for anonymised publication.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Robin P Choudhury, Professor, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
Telephone: +44-1865-234664 Fax: +44-1865-234667
Received: June 1, 2016
Peer-review started: June 3, 2016
First decision: July 5, 2016
Revised: September 29, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: February 16, 2017

A 54-year-old black African woman, 22 years human immunodeficiency virus (HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.

Keywords: Coronary artery disease, Restenosis, Human immunodeficiency virus

Core tip: With an increasing burden of cardiovascular disease in patients with human immunodeficiency virus (HIV), a subgroup of patients may emerge in whom this represents a significant clinical challenge. Better understanding of the responsible mechanisms may allow more tailored pharmacotherapy for susceptible individuals. We report an exceptionally aggressive and recurrent case of coronary stent restenosis in HIV positive patient. Numerous percutaneous interventions were performed but eventually patient was treated successfully with surgical revascularisation.