Author + information
- Received May 26, 2015
- Accepted June 5, 2015
- Published online October 1, 2015.
- Akihito Tanaka, MD∗,†,
- Neil Ruparelia, DPhil∗,†,‡,
- Hiroyoshi Kawamoto, MD∗,†,
- Azeem Latib, MD∗,† and
- Antonio Colombo, MD∗,†∗ ()
- ∗Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
- †Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- ‡Imperial College, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy.
A 71-year-old man underwent successful percutaneous coronary intervention to treat a chronic total occlusion (CTO) of the left circumflex artery (LCx) with implantation of a 3.0 × 18-mm and 2.5 × 28-mm Absorb bioresorbable scaffold (BRS) (Abbott Vascular, Santa Clara, California) (Figure 1) (1). A further BRS was implanted in the first major obtuse marginal branch (OM1).
After 32 months, he presented with a recurrence of angina and underwent coronary angiography, which demonstrated distal edge restenosis of the BRS in OM1 (Figure 1C), which was treated with drug-eluting stents (Figure 1D). Further intravascular ultrasound was performed in the main branch of the LCx, which demonstrated positive remodeling of the vessel with enlargement of the lumen at the previous CTO site (Figure 2A). Additionally, pulsatile motion of the vessel was observed, suggesting restoration of some native vessel function (Figure 2B, Online Video 1). Of note, this was in the presence of some remaining struts, indicating incomplete resorption of the BRS at this time point.
The outcome data published to date after BRS implantation has been in the context of relatively “simple” lesions (2), with limited data after the treatment of complex lesions, in particular CTO. CTO lesions often result in vessel shrinkage (3), which requires the implantation of smaller stents. In this case, nearly 3 years after the index procedure, we observed positive remodeling of the vessel in conjunction with significant lumen enlargement that would have not been possible in the presence of a permanent metal cage. Furthermore, we noted pulsatile motion of the vessel wall at the BRS site. Pharmacologically induced vasomotion of the BRS segment has been shown (4), and natural pulsatile motion should recover after resorption of the BRS. This case suggests that after implantation of a BRS, even in the context of CTO lesions, vessels may positively remodel and regain some native vessel wall function.
For the accompanying video, please see the online version of this article.
Dr. Latib serves on the Advisory Board of Medtronic; and has received honorarium from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 26, 2015.
- Accepted June 5, 2015.
- American College of Cardiology Foundation
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