Author + information
- Received August 6, 2014
- Accepted August 29, 2014
- Published online January 1, 2015.
- Yohei Ohno, MD∗,
- Andrea Mangiameli, MD∗,
- Guilherme F. Attizzani, MD∗,†,
- Davide Capodanno, MD, PhD∗,‡∗ ( and )
- Corrado Tamburino, MD, PhD∗,‡
- ∗Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- †Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
- ‡Excellence Through Newest Advances Foundation, Catania, Italy
- ↵∗Reprint requests and correspondence:
Prof. Davide Capodanno, Cardiovascular Department, Ferrarotto Hospital, University of Catania, Via Citelli 29, Catania 95124, Italy.
A 48-year-old man was admitted because of a non–ST-segment elevation myocardial infarction. Fifteen months previously, he had received a 3.0 × 28-mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) in the mid-left anterior descending coronary artery for stable angina. Coronary angiography showed a focal in-scaffold restenosis (Figure 1A). Optical coherence tomography (OCT) (Ilumien, St. Jude Medical, Saint Paul, Minnesota) revealed a heterogeneous pattern consisting of neointimal hyperplasia (Figure 1C), mural white thrombus (Figure 1C), and lipidic plaque with attenuation (Figure 1D). OCT after pre-dilation with a 2.0 × 15-mm semicompliant balloon showed outer migration of scaffold struts (Figures 1E, 1G, and 1H) visible in several frames leading to intra-scaffold dissection (Figures 1E to 1H) extending behind the disrupted scaffolds. Good angiographic result was obtained after 3.0 × 15-mm noncompliant balloon and abciximab infusion (Figure 1B); no further intervention was performed.
Although BVS promotes acute vessel scaffolding similar to metallic stents, it carries a unique feature of complete resorption approximately 3 years after implantation (1). It is known that 6 months after the implantation, BVS loses radial strength and structural continuity; therefore, it no longer functions as a scaffold (2), which was likely the potential mechanism that favored in-scaffold dissection after balloon dilation in the present case. Although clinicians should be aware that in-scaffold dissections might occur after performing in-BVS balloon dilation for late BVS failure (i.e., theoretically after 6 months), as herewith presented, the best management of BVS restenosis (i.e., implanting another BVS-in-BVS or balloon dilation only) remains to be determined.
Dr. Attizzani has received consulting fees from St Jude Medical. Dr. Tamburino has received speaker honoraria from Abbott Vascular. All other authors have reported that they no relationships relevant to the contents of this paper to disclose.
- Received August 6, 2014.
- Accepted August 29, 2014.
- American College of Cardiology Foundation