Author + information
- Received September 12, 2014
- Accepted October 8, 2014
- Published online March 1, 2015.
- Giuseppe Gargiulo, MD∗,
- Andrea Mangiameli, MD∗,
- Francesco Granata, MD∗,
- Yohei Ohno, MD∗,
- Alberto Chisari, MD∗,
- Davide Capodanno, MD, PhD∗,†∗ (, )
- Corrado Tamburino, MD, PhD∗,† and
- Alessio La Manna, MD∗
- ∗Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
- †Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
- ↵∗Reprint requests and correspondence:
Dr. Davide Capodanno, University of Catania, Cardiovascular Department, Ferrarotto Hospital, via Citelli 1, 95124 Catania, Italy.
A 60-year-old man with a chronic total occlusion of the left anterior descending coronary artery (LAD) (Figure 1A) and evidence of myocardium viability was successfully treated with percutaneous coronary intervention. Four overlapping bioresorbable vascular scaffolds (BVS; Abbott Vascular, Santa Clara, California) were implanted: 2.5 × 28 mm, 3.0 × 28 mm, 3.5 × 28 mm, and 3.5 × 28 mm from distal to proximal, respectively (“full polymer jacket”) (Figure 1B) (1). Optical coherence tomography (OCT; Ilumien, St. Jude Medical, St. Paul, Minnesota) showed good expansion of the scaffolds and good apposition of the struts (Figures 1a to 1g). At 8 months, elective angiographic follow-up documented a focal coronary artery aneurysm (CAA) at the mid-segment of the LAD (Figure 1C) (2). OCT revealed a CAA maximal lumen area of 16.4 mm2 with a longitudinal length of 8.4 mm in the absence of thrombus. At the CAA site, most of the BVS struts were embedded in the aneurysmal wall and covered by neointima, whereas late-acquired incomplete scaffold apposition (ISA) was noted in some cross sections (Figures 1a′ to 1g′). To our knowledge, this is the first described case of new-onset CAA and late-acquired ISA after BVS implantation. Potential mechanisms of late-acquired ISA after chronic total occlusion percutaneous coronary intervention include guidewire injury to the adventitial layer, creation of a false lumen, or subintimal stenting (3). With BVS, the management is uncertain, not automatically resembling that of CAA developed after metallic stenting (2). The potential consequences of balloon angioplasty or stent implantation inside a BVS that has lost its integrity as a result of the bioresorption process are unknown. A “watchful waiting” strategy with long-term dual antiplatelet therapy and early follow-up was adopted.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2014.
- Accepted October 8, 2014.
- 2015 American College of Cardiology Foundation
- Aoki J.,
- Kirtane A.,
- Leon M.B.,
- Dangas G.
- Attizzani G.F.,
- Capodanno D.,
- Ohno Y.,
- Tamburino C.