Author + information
- Received October 3, 2016
- Revision received October 9, 2016
- Accepted October 20, 2016
- Published online January 16, 2017.
- Tommaso Gori, MD, PhD∗ ( and )
- Thomas Münzel, MD
- Kardiologie I, Zentrum für Kardiologie, University Medical Center of Mainz, and DZHK-standort Rhein Main, Germany
- ↵∗Reprint requests and correspondence:
Dr. Tommaso Gori, Department of Cardiology, University Medical Center Mainz, Langenbeckerstrasse 1, Mainz 55131, Germany.
In December 2012, a 76-year-old woman with a history of hypertension underwent coronary angiography for ST-segment elevation myocardial infarction. A subocclusive lesion in the proximal left anterior descending coronary artery (Figure 1A) was pre-dilated with a 2.5 × 15-mm balloon and a 3.0 × 18-mm coronary bioresorbable scaffold (Absorb, Abbott Vascular, Abbott Park, Illinois) was implanted (Figure 1B). Discharge medication included prasugrel 10 mg and aspirin 100 mg.
In December 2013, the patient underwent scheduled control angiography and optical coherence tomography assessment, which demonstrated patency of the scaffold with <10% angiographic restenosis (Figures 1C, 1D, 2A, and 2B), good apposition and expansion of the scaffold struts. On optical coherence tomography imaging, the remnants of the culprit plaque were covered by a 130-μm layer of fibrous neointima (Figure 2A). In the 3-dimensional reconstruction (Figure 2B), the pattern of the scaffold struts was still visible. The maximal dilation to intracoronary acetylcholine and nitroglycerin 200 μg were 7.8% and 9.1%, respectively.
Repeat coronary angiography performed in September 2016 showed the persistence of an optimal result. Quantitative coronary angiography showed evidence of late luminal gain (from 2.3 to 2.78 mm), invasive imaging demonstrated the complete resorption of the scaffold struts (“golden tube”) (Figures 1D, 1E, 2C, and 2D), and the plaque presented characteristics of stability, including a 330 μm-thick fibrous cap, no evidence of microvessels or macrophages, and a calcific pattern (Figure 2C). The maximal dilation to intracoronary acetylcholine and nitroglycerin were 6.1% and 7.2%, respectively.
This is, to our knowledge, the first report of a “golden tube” after bioresorbable scaffold implantation for the treatment of an ST-segment elevation myocardial infarction. The persistence of vasomotion and anatomic stabilization of the plaque (already shown at 1 year) (1) support this therapeutic concept.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 3, 2016.
- Revision received October 9, 2016.
- Accepted October 20, 2016.
- American College of Cardiology Foundation