Hybrid Stent Strategy in a 37-Year-Old Man Undergoing PCI: A Rare Contemporary Practice Case Report

Abstract

Background and Purpose: Drug-eluting stents (DES) are the standard of care in contemporary percutaneous coronary intervention (PCI), with bare-metal stents (BMS) now rarely used. Hybrid stent strategies—using DES and BMS in the same vessel—have become uncommon, especially in young adults. However, certain lesion anatomies or vessel characteristics may still justify a mixed approach. This case report describes the rationale and clinical outcome of a hybrid DES+BMS PCI in a 37-year-old patient presenting with acute coronary syndrome.

 Methods: A 37-year-old man presented with exertional chest pain and was diagnosed with non–ST elevation acute coronary syndrome. Coronary angiography demonstrated a significant proximal lesion and an extended mid-to-distal lesion within a large-caliber vessel. Based on vessel morphology, restenosis risk, and stent expansion requirements, a hybrid stenting strategy was selected. Procedural decisions, angiographic results, and early clinical outcomes were recorded and analyzed descriptively. No statistical analysis was applicable, as this is a single-patient case report.

 Results: A second-generation DES was deployed in the proximal segment to minimize restenosis risk, followed by placement of a large-diameter BMS in the mid-to-distal segment to optimize expansion and accommodate vessel size. Final angiography demonstrated excellent stent apposition and TIMI III flow with no residual stenosis. The patient’s recovery was uncomplicated, and he was discharged on guideline-directed dual antiplatelet therapy. At follow-up, he reported resolution of symptoms with no adverse events.

Conclusions: This case highlights that although rare in current practice, hybrid stent strategies remain valuable in select anatomical situations. In young patients with atypical lesion distribution, individualized stent selection can optimize procedural outcomes while maintaining low restenosis risk. Hybrid DES+BMS PCI may still serve as a practical and effective approach when carefully justified by vessel characteristics.