A 79-Year-Old Man with a History of Ischemic Heart Disease Presenting with Right Coronary Artery Aorto-Ostial Stent Deformity and Restenosis: A Case Report

BACKGROUND Ostial right coronary artery (RCA) involvement is a relatively uncommon location for coronary artery disease and requires consideration of anatomic factors (aortic root involvement) and potential increased recoil. This makes stent placement prone to a geographic miss, especially in the context of limitations associated with two-dimensional coronary angiography. Moreover, the design of newer stent generations, which allows for easier deliverability but with increased susceptibility to mechanical damage, may place them at increased risk for longitudinal deformity when deployed in the right coronary ostium. This report describes the case of a 79-year-old man with a history of ischemic heart disease presenting with RCA aorto-ostial stent deformity and restenosis. CASE REPORT The patient presented with acute-onset ischemic chest pain and was found to have non-ST-elevation myocardial infarction (NSTEMI). Coronary angiography revealed significant 2-vessel coronary artery disease involving the mid-portion of the left anterior descending artery and the ostium of the RCA. The latter was due to associated in-stent restenosis of an overhanging stent protruding into the aorta. The patient underwent coronary artery bypass graft surgery with removal of the displaced stent, which was found to have evidence of a longitudinal deformity in its middle portion. CONCLUSIONS This report highlights a rare but important complication of the use of coronary artery stents, particularly when used in the region of the RCA ostium, and the management of stent deformity and restenosis.