Author + information
- Received July 18, 2015
- Revision received September 14, 2015
- Accepted September 24, 2015
- Published online January 11, 2016.
- ∗Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom
- †Department of Interventional Cardiology, New Tokyo Hospital, Chiba, Japan
- ↵∗Reprint requests and correspondence:
Dr. Sandeep Basavarajaiah, Heart of England NHS Trust, Rectory Road, Sutton Coldfield, Birmingham, United Kingdom B75 5RR.
A 33-year-old man presented with chest pain and dynamic ST-segment elevation in the anterior leads. Coronary angiography revealed dissection in the mid-segment of the left anterior descending coronary artery (LAD) with luminal compression and Thrombolysis In Myocardial Infarction flow grade 2 (Figure 1, Online Video 1). This was confirmed on the subsequently performed optical coherence tomography (OCT) (Figure 2). Given his young age, we deployed 2 overlapping bioresorbable vascular scaffolds (BVS) (3.0 × 18 mm and 3.5 × 28 mm), achieving good angiographic and OCT results (Figure 3, Online Video 2). Despite this, we were concerned about the hematoma segment, that scaffolds may become malapposed following hematoma resolution. So, we reimaged the LAD 5 months later, which showed continued good results on angiogram, but more importantly, the OCT revealed the absence of any malapposed scaffolds (Figure 4, Online Videos 3, 4, 5, and 6). The OCT measurements have revealed higher values at follow-up than measured following angioplasty, indicating expansion of the scaffolds (Figure 5). Furthermore, the average measurements carried out at every millimeter length in the hematoma segment have also demonstrated similar findings. The average values post-procedure and at follow-up were:
• Inner BVS area: 6.4 ± 0.6 mm2 versus 7.1 ± 0.5 mm2
• Inner BVS diameter: 2.8 ± 0.1 mm versus 3.0 ± 0.1 mm
• Outer BVS area: 8.3 ± 0.7 mm2 versus 8.5 ± 0.5 mm2
• Outer BVS diameter: 3.2 ± 0.1 mm versus 3.3 ± 0.1 mm
Use of BVS is ideal in young patients requiring long-segment stenting especially in the LAD. Malapposed stent struts following hematoma resolution have been reported in drug-eluting stents, which increases the risk of stent thrombosis by creation of dead space (1,2). Our case demonstrated that use of BVS is safe in dissection, and OCT images have revealed expansion of scaffolds post-hematoma resolution. This is an important finding and should encourage use of BVS in such scenarios.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 18, 2015.
- Revision received September 14, 2015.
- Accepted September 24, 2015.
- 2016 American College of Cardiology Foundation