OBJECTIVE To investigate the link and potential mechanisms of lenvatinib-induced severe coronary artery stenosis in hepatocellular carcinoma patients, and provide a reference for clinical rational drug use.

METHODS Retrospective analysis of the clinical diagnosis and treatment process of a patient with hepatocellular carcinoma who developed severe coronary artery stenosis after treatment with lenvatinib, combined with relevant literature, to evaluate the causal relationship between the medication and the adverse reaction, and to explore its possible pathogenic mechanisms.

RESULTS The Naranjo’s adverse drug reaction probability scale yielded a score of 8, indicating a ‘probable’ causal relationship.

CONCLUSION The pathogenesis of lenvatinib-induced severe coronary artery stenosis may be associated with inhibited endothelial repair function, vascular endothelial dysfunction, activation of chronic inflammatory responses, alterations in plaque morphological characteristics, hemodynamic abnormalities, and compromised compensation from collateral circulation. Before initiating lenvatinib therapy, clinicians should routinely conduct a detailed cardiovascular risk assessment for patients, optimize management of blood pressure, blood glucose, and blood lipids, and ensure early detection and intervention.