TY - JOUR
T1 - Different behaviors of bioresorbable vascular scaffold in different types of calcified lesion
T2 - Insights from intravascular imaging
AU - Mitomo, Satoru
AU - Tanaka, Akihito
AU - Candilio, Luciano
AU - Azzalini, Lorenzo
AU - Carlino, Mauro
AU - Latib, Azeem
AU - Colombo, Antonio
N1 - Publisher Copyright:
© 2017 Japanese College of Cardiology
PY - 2018/4
Y1 - 2018/4
N2 - A 55-year-old male underwent percutaneous coronary intervention (PCI) for left anterior descending artery chronic total occlusion. After lesion preparation with non-compliant (NC) balloon, two bioresorbable vascular scaffolds (2.5/28 mm, 3.0/28 mm, Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) were implanted followed by 1:1 sized NC balloon post-dilatation at 20 atm. Final intravascular ultrasound (IVUS) showed acceptable BVS expansion in diffusely calcified lesions. Twenty-one months’ follow-up coronary angiography revealed severe restenosis with reocclusion at the distal edge of the distal BVS. After recanalization with a 1.0 mm balloon, optical coherence tomography (OCT) was performed. Quantitative analysis comparing OCT and IVUS at the index procedure demonstrated that minimum scaffold area at follow-up became significantly smaller and with higher eccentricity, suggesting severe recoil at the lesions with thick calcium spot, whereas these changes were not observed at the lesion with relatively thin calcification. The lesions were successfully revascularized with drug-eluting stents and final OCT showed symmetric expansion of metallic stents. Our case demonstrates that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide PCI strategy with BVS. <Learning objective: Calcified lesions represent a challenging lesion subset for bioresorbable vascular scaffold (BVS) because of less radial strength of the latter. Quantitative analysis with intravascular imaging demonstrated that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide percutaneous coronary intervention strategy with BVS.>
AB - A 55-year-old male underwent percutaneous coronary intervention (PCI) for left anterior descending artery chronic total occlusion. After lesion preparation with non-compliant (NC) balloon, two bioresorbable vascular scaffolds (2.5/28 mm, 3.0/28 mm, Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) were implanted followed by 1:1 sized NC balloon post-dilatation at 20 atm. Final intravascular ultrasound (IVUS) showed acceptable BVS expansion in diffusely calcified lesions. Twenty-one months’ follow-up coronary angiography revealed severe restenosis with reocclusion at the distal edge of the distal BVS. After recanalization with a 1.0 mm balloon, optical coherence tomography (OCT) was performed. Quantitative analysis comparing OCT and IVUS at the index procedure demonstrated that minimum scaffold area at follow-up became significantly smaller and with higher eccentricity, suggesting severe recoil at the lesions with thick calcium spot, whereas these changes were not observed at the lesion with relatively thin calcification. The lesions were successfully revascularized with drug-eluting stents and final OCT showed symmetric expansion of metallic stents. Our case demonstrates that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide PCI strategy with BVS. <Learning objective: Calcified lesions represent a challenging lesion subset for bioresorbable vascular scaffold (BVS) because of less radial strength of the latter. Quantitative analysis with intravascular imaging demonstrated that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide percutaneous coronary intervention strategy with BVS.>
KW - Bioresorbable vascular scaffold
KW - Calcified lesion
KW - Intravascular ultrasound
KW - Optical coherence tomography
KW - Recoil
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U2 - 10.1016/j.jccase.2017.12.003
DO - 10.1016/j.jccase.2017.12.003
M3 - Article
AN - SCOPUS:85039798074
SN - 1878-5409
VL - 17
SP - 126
EP - 129
JO - Journal of Cardiology Cases
JF - Journal of Cardiology Cases
IS - 4
ER -