Abstract
BACKGROUND: Recurrent in-stent restenosis (RISR) remains a therapeutic challenge when conventional treatments show limited efficacy. This case series evaluated a prednisone-based therapeutic strategy in patients with unexplained RISR. METHODS: In this single-center prospective case series, 6 patients with RISR were included after exclusion of procedural failure, neoatherosclerosis, and systemic vasculitis by intracoronary imaging and laboratory testing. All patients had failed repeated revascularization and optimal medical therapy. Oral prednisone (0.5 mg/kg/d) was initiated and tapered monthly by 5 mg/d until a maintenance dose of 5-10 mg/d was achieved alongside guideline-directed therapy. RESULTS: Over a median follow-up of 4-years, 5 patients remained free from in-stent restenosis recurrence during treatment. One exhibited persistent in-stent restenosis but eventually achieved lesion stabilization after escalation to combined immunosuppressive therapy. Imaging demonstrated fibrotic neointimal hyperplasia without lipid-rich features. No serious steroid-related adverse events were observed. CONCLUSIONS: Prednisone-based anti-inflammatory therapy may represent a potential strategy for the management of refractory RISR. TAKE-HOME MESSAGES: Refractory RISR may represent an under-recognized inflammatory vascular process rather than purely mechanical failure. In selected patients who have exhausted conventional revascularization strategies, systemic anti-inflammatory therapy may offer a viable therapeutic alternative.