Author + information
- Received March 26, 2013
- Accepted April 11, 2013
- Published online December 1, 2013.
- Charis Costopoulos, MD∗,†,‡,
- Toru Naganuma, MD∗,†,
- Azeem Latib, MD∗,† and
- Antonio Colombo, MD∗,†∗ ()
- ∗Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- †Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
- ‡Interventional Cardiology Unit, Imperial College London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy.
A 51-year-old man was referred for coronary angiography following a positive scintigraphy test for anterior and anterolateral ischemia. Angiography showed a chronic total occlusion of the mid-left anterior descending coronary artery (LAD) and stenosis of the ostial first diagonal branch (Fig. 1). The total occlusion of the LAD was crossed, and rotablation was performed. A 2.5 × 28-mm Absorb bioresorbable vascular scaffold (BVS) stent (Abbott Vascular, Santa Clara, California) was implanted in the LAD just distal to the first diagonal. A second 2.5 × 18-mm Absorb was implanted in the first diagonal branch. Optical coherence tomography (OCT) imaging demonstrated that the BVS implanted on the diagonal was protruding into the LAD by approximately 4 mm. This protrusion was crushed onto the LAD with a balloon inflation, and a third 3.0 × 28-mm Absorb stent was implanted in the LAD, straddling the origin of the diagonal. Subsequent OCT demonstrated inadequate “crush” of the diagonal scaffold struts. Following high-pressure post-dilation in both branches and final kissing balloon inflation, acceptable BVS apposition was achieved (Fig. 2).
Concerns regarding the use of BVS stents in bifurcation lesions exist due to their large strut thickness, which may result in a thick scaffold segment when a systematic 2-stent strategy is utilized (1). The OCT images presented here indicate that this concern may be valid, but the final result can be acceptable by selecting large vessels, ideally >3.0 mm in diameter. Intravascular imaging and meticulous post-dilation will help ensure good apposition of crushed struts to the vessel wall. This will reduce the risk of early restenosis and stent thrombosis, whereas the eventual resorption of the scaffold may also prevent both of these in the future.
Dr. Latib serves on the Medtronic advisory board. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 26, 2013.
- Accepted April 11, 2013.
- American College of Cardiology Foundation