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Section on Endovascular Stenting from BIG ROBBINS (for people like me who need more context):
I think the key here is that this patient already had a stent placed, was symptom free for a few months, and now has angina with exertion. Angina with exertion is describing "Stable angina", the angina is due to "demand ischemia". The most common cause of stable angina is atherosclerosis/atherosclerotic plaque build up and a very common adverse effect of stents is neointima formation/ forming a new plaque on the stent.... a thrombosis would cause angina at both rest and with exercise, due to "supply ischemia", and it would be more acute, not progressive like the question stem describes
Another thing to note: they could have made this question even trickier by asking whether or not you know which leads are associated with which arteries. This person had LAD and RCA stent placement. That means that they could have given you leads II, III, aVF (for RCA probs) or V1-V6, I, aVL (for LAD probs) and make you choose based on that.
This question was easier since all answers are regarding the RCA.