Author + information
- Received January 2, 2015
- Accepted January 15, 2015
- Published online May 1, 2015.
- Toru Naganuma, MD∗,†,‡,
- Vasileios F. Panoulas, MD∗,†,§,
- Azeem Latib, MD∗,†,
- Hiroyoshi Kawamoto, MD∗,†,‡,
- Katsumasa Sato, MD∗,†,
- Tadashi Miyazaki, 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
- §National Heart and Lung Institute, 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.
- bioresorbable vascular scaffold
- coronary bifurcation
- optical coherence tomography
- T-stenting with small protrusion technique
A 75-year-old man with stable angina underwent coronary angiography demonstrating significant stenosis at the bifurcation of the left anterior descending coronary artery (LAD) with a diagonal branch (Figure 1A). Following pre-dilation, a 3.5 × 28-mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) was implanted in the LAD. This was followed by post-dilation with a 3.5-mm noncompliant balloon and subsequent “T kissing” inflation. Because of an extensive dissection in the proximal segment of the diagonal (Figure 1B), a 2.5 × 28-mm everolimus-eluting stent (EES) was implanted using the T-stenting with small protrusion (TAP) technique followed by “T kissing” inflation (Figures 1C and 1D). A post-procedural angiography showed an excellent result (Figures 1E and 1F). Optical coherence tomography (OCT) demonstrated a 1.9-mm-length “hybrid” neocarina consisting of BVS and EES struts with no evidence of BVS disruption (Figures 2A to 2I). Follow-up angiogram at 14 months demonstrated an excellent result at the bifurcation treated with hybrid TAP (Figure 2A′). The patient was still on dual antiplatelet therapy at the time. OCT showed neointima formation with homogeneous hyperplasia from the base of the neocarina towards its peak (Figures 2B′ to 2I′) with no evidence of thrombi. The top edge of the neocarina (peak), consisting only of metallic struts, was not fully covered by neointima (Figures 2B′ and 2C′).
Provisional single stenting is considered the preferred strategy for the treatment of coronary bifurcation lesions (1). In cases where the flow to the side branch is compromised following main-branch stenting, stent implantation in the side branch should be considered (2). This strategy should be adopted even when BVS has been implanted in the main branch. However, in some cases, the delivery of additional BVS into the side branch may be difficult because of the strut thickness (157 μm). In these cases, the combination of BVS implantation in the main branch and conventional drug-eluting stent in the side branch should be considered.
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 January 2, 2015.
- Accepted January 15, 2015.
- 2015 American College of Cardiology Foundation