Thinner is not always better: Focal in-stent restenosis with stent deformation at coronary bend following ultrathin-strut drug-eluting stent implantation

We describe a 64-year-old male who underwent percutaneous coronary intervention of an angulated right coronary artery lesion using overlapping ultrathin-strut everolimus-eluting stents. Although the initial angiographic result was optimal, the patient developed recurrent angina at six months, and repeat angiography revealed focal in-stent restenosis localised to the coronary bends with fluoroscopic evidence of stent deformation. The overlap segment was relatively spared. Repeat intervention with a conventional thin-strut DES resulted in excellent clinical and angiographic outcomes at one-year follow-up. This case underscores the importance of unfavourable outcome of ultrathin strut DES at coronary bends, possibly secondary to poor radial strength leading to stent deformation and in-stent restenosis.