An Atherosclerotic Systemic Sclerosis
A 65-year-old woman with systemic sclerosis, World Health Organization Group 1 pulmonary arterial hypertension, and essential hypertension and without other cardiovascular risk factors was admitted for atypical angina. During the admission, echocardiography showed normal systolic function. The patient underwent coronary angiography, which showed a severe stenosis of the left anterior descending artery that was treated initially with predilation and then with a drug-eluting stent (Figure 1).
After 2 years, the patient was admitted for another episode of atypical angina. During the recovery, the patient repeated coronary angiography along with intravascular ultrasound study that showed a patent stent (Figure 2).
What is the most likely cause of the re-presentation of angina in this patient?