Author + information
- Received October 28, 2015
- Accepted November 7, 2015
- Published online February 22, 2016.
- Jonathan Watt, MB, ChB, MD∗ (, )
- Mohaned Egred, MB, ChB, MD,
- Ayush Khurana, MB, ChB,
- Alan J. Bagnall, MB, ChB, PhD and
- Azfar G. Zaman, MB, ChB, MD
- ↵∗Reprint requests and correspondence:
Dr. Jonathan Watt, Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, United Kingdom.
A 32-year-old woman with chest pain and anterior ST-segment elevation myocardial infarction was referred to our institution for primary percutaneous coronary intervention. Coronary angiography showed severe left main stem (LMS) and left anterior descending coronary artery (LAD) stenosis (Figures 1A and 1B). Intravascular ultrasound (IVUS) revealed spontaneous coronary artery dissection (SCAD) with extensive intramural hematoma (IMH) (Figures 1C and 1D). Four minimally overlapped Absorb bioresorbable scaffolds (BRS) (Abbott Vascular, Abbott Park, Illinois) were implanted from the distal LAD to the LMS (3.0 × 28 mm; 3.5 × 28 mm; 3.5 × 12 mm, and 3.5 × 28 mm) and post-dilated with 3.5 mm and 4.0 mm noncompliant balloons with a good final result achieved (Figures 1E and 1F). Optical coherence tomography showed excellent expansion and well-apposed scaffolds. After 1 year, the patient complained of throat tightness, therefore repeat angiography was performed showing widely patent BRS (Figures 2A and 2B). Optical frequency domain imaging showed good scaffold expansion with tissue coverage of all BRS struts (Figure 2C), although malapposition was prevalent, predominantly near bifurcations (Figure 2D, Online Video 1). No further intervention was performed, but continuation of dual antiplatelet therapy was recommended.
SCAD can often be treated conservatively, but in refractory ischemia, BRS are an appealing way to avoid a permanent implant (1). To our knowledge, no follow-up intracoronary imaging for SCAD treated with BRS has been reported. We have shown that multiple BRS are feasible to treat extensive SCAD. After 1 year, malapposition of BRS struts may occur; this is likely caused by resorption of IMH (2). BRS may be preferable to life-long malapposition of metallic stents. Optimal scaffold expansion and strut tissue coverage are likely to reduce the risk of late thrombosis. We intend to continue dual antiplatelet therapy until BRS resorption after 2 years. We believe that implantation of BRS may represent an attractive strategy when intervention for SCAD is absolutely necessary.
For a supplemental video and its legend, please see the online version of this article.
Dr. Egred is a proctor for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 28, 2015.
- Accepted November 7, 2015.
- American College of Cardiology Foundation