Author + information
- Received July 23, 2013
- Accepted August 1, 2013
- Published online May 1, 2014.
- Toru Naganuma, MD∗,†,
- Charis Costopoulos, MD∗,†,
- Azeem Latib, MD∗,†,
- Katsumasa Sato, MD∗,†,
- Tadashi Miyazaki, MD∗,† and
- Antonio Colombo, MD∗,†∗ ()
- ∗Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- †Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy.
A 70-year-old man underwent coronary angio-graphy that demonstrated in-stent restenosis (ISR) and long calcified disease extending from the left main stem (LMS) to the left anterior descending coronary artery (LAD), with involvement of the LAD/diagonal bifurcation (Fig. 1A). After rotational atherectomy (1.5-mm burr) and aggressive pre-dilation, a mini-crush technique was utilized with a 2.25 × 12-mm everolimus-eluting stent (EES) implanted in the diagonal ostium. The protruding EES was crushed with a balloon (Figs. 1B to 1G), followed by the implantation of a 3.5 × 28-mm ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) that also covered the restenotic segment. After kissing balloon inflation, 2 further BVS were implanted distally with minimal overlap. The procedure was completed with the implantation of a 4.0 × 12-mm EES in the LMS followed by a 4.5-mm balloon dilation. Optical coherence tomography demonstrated a crushed diagonal EES and an adequately expanded, well-apposed BVS without any evidence of scaffold disruption (Figs. 2A–2E). Three-month follow-up angiography showed no evidence of scaffold recoil and restenosis (Fig. 2F).
Although BVS has been used for complex lesions (1,2), its use for the treatment of ISR has yet to be reported. BVS use in this context is particularly attractive because it avoids the addition of further metal layers, and this, in conjunction with its greater biocompatibility as compared with conventional stents, can potentially reduce the risk of recurrent restenosis and stent thrombosis. This case also demonstrates that BVS can be successfully used for the treatment of diffusely diseased, heavily calcified vessels, as well as in systematic 2-stent strategies for the treatment of bifurcation lesions. Follow-up angiography suggests that as long as meticulous lesion preparation, appropriate BVS sizing, and adequate post-dilation are performed, BVS can achieve excellent results, at least at early follow-up. Longer-term data are, however, required to fully investigate the role of BVS in these complex lesions.
Dr. Latib has served on the advisory board of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 23, 2013.
- Accepted August 1, 2013.
- American College of Cardiology Foundation
- Serruys PW, Onuma Y. Preliminary data from ABSORB EXTEND: a report of the 12-month clinical outcomes from the first 450 patients enrolled. Paper presented at: EUROPCR annual meeting; May 23, 2013; Paris, France.