Author + information
- Received April 7, 2014
- Accepted April 10, 2014
- Published online October 1, 2014.
- Toru Naganuma, MD∗,†,‡,
- Azeem Latib, MD∗,†,
- Vasileios F. Panoulas, MD∗,†,§,
- Katsumasa Sato, MD∗,†,
- Tadashi Miyazaki, MD∗,†,
- Sunao Nakamura, 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, New Tokyo Hospital, Chiba, Japan
- §Imperial College London, National Heart and Lung Institute, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, Cardiac Catheterization Laboratory, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy.
A 70-year-old male underwent coronary angiography because of worsening angina, which demonstrated proximal left anterior descending coronary artery (LAD) chronic total occlusion (CTO) collateralized by septal branches from the right coronary artery and an antegrade bridge (Figure 1A). The lesion was penetrated using retrograde subintimal tracking (Figure 1B). Intravascular ultrasound (IVUS) after pre-dilation with a 2.5-mm balloon demonstrated that the retrograde guidewire entered into subintimal space because of calcification (Figure 1C, a and b). The re-entry point to the true lumen was distal to the LAD ostium (Figure 1C, c). A total of 2 bioresorbable vascular scaffolds (BVS) (Abbott Vascular, Santa Clara, California) were implanted without scaffold overlap, followed by post-dilation with a 3.25-mm noncompliant balloon. Post-procedural IVUS showed well-expanded BVS within the subintimal space and a collapsed true lumen (Figure 2A, a–e). At that time, there was no evidence of strut malapposition.
One-year follow-up angiography showed excellent results in BVS-treated segments (Figure 2B). Optical coherence tomography (OCT) demonstrated acceptable scaffold and lumen areas with homogeneous neointimal hyperplasia similar to the one reported in the context of non-CTO lesions (1). Furthermore, there was no evidence of intraluminal masses. The patient remained on dual antiplatelet therapy since his index procedure. Of note, partial strut malapposition was noted on OCT that may be possibly due to: 1) absorption of hematoma or thrombus; 2) late scaffold recoil; and/or 3) low sensitivity of IVUS to assess for strut malapposition as compared with OCT. This case suggests the feasibility of BVS use in a CTO lesion as well as its efficacy up to 1-year follow-up.
Dr. Latib is on the advisory board of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 7, 2014.
- Accepted April 10, 2014.
- American College of Cardiology Foundation