Author + information
- Received September 19, 2016
- Accepted September 22, 2016
- Published online December 21, 2016.
- S1936879816316570-0ff449475799e2d021fc7e938f64fb68Felix Meincke, MDa,∗ (, )
- S1936879816316570-856049c16347b4f723f84893769a7bbeClaudia Reinholz, MDa,
- S1936879816316570-0d82da42111e82a221ed83fa0048a342Tobias Spangenberg, MDa,
- S1936879816316570-4e40f34e7e1247e3782b41d282429a31Hendrik Wienemann, MDa,
- S1936879816316570-d970cf57819b28cb4c5550fa8c9820ffAref Arjomand, MDa,
- S1936879816316570-475e3fd076c65fe9ced0709364db365dFelix Kreidel, MDa,
- S1936879816316570-a7a0ed81b053a586fc019a0fa7f17fc1Karl-Heinz Kuck, MDa and
- S1936879816316570-4f8232426f6896c0d71a378a4a81ec4dAlexander Ghanem, MDa,b
- aAsklepios Klinik St. Georg, Department for Cardiology, Hamburg, Germany
- bMedizinische Klinik II, Universitaetsklinikum Bonn, Bonn, Germany
- ↵∗Reprint request and correspondence:
Dr. Felix Meincke, Asklepios Klinik St. Georg, Kardiologie, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.
A 33-year-old man underwent routine percutaneous coronary intervention for a left anterior descending artery stenosis (fractional flow reserve 0.79) (Figure 1A). After stepwise pre-dilation up to 3.0 mm, a 3.5 × 28-mm Novolimus-eluting bioresorbable vascular scaffold (NE-BVS) (Elixir Medical, Sunnyvale, California) was implanted followed by post-dilation up to a 4.0-mm noncompliant balloon due to initial angiographically insufficient stent deployment (Figure 1B). Six months after implantation, routine angiography revealed a large aneurysm at the site of prior BVS implantation (Figure 1C). Given the rapidness of development with a subsequent high danger of rupture, the decision was made for percutaneous treatment. Thus, 2 polytetrafluoroethylene (PTFE)-covered stents (PK Papyrus, Biotronik, Berlin, Germany) were implanted and subsequently completely covered with a conventional everolimus-eluting stent (4.0 × 38 mm) in order to minimize the risk of restenosis. Angiography after implantation showed only a minimal type 1a endo-leak (Figure 1D). Follow-up another 4 months later ruled out a persistent leak and restenosis (Figures 1E and 1F).
The reported case raises the question whether the increased intensity of pre- and post-dilation during implantation of BVS might elevate the risk for the development of coronary aneurysms and at the same time demonstrates a safe and simple way of dealing with this challenge. A contributing factor might also be the unique process of vascular remodeling after BVS implantation, which is obviously different as compared with conventional drug-eluting stents and has yet to be fully understood.
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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2016.
- Accepted September 22, 2016.
- American College of Cardiology Foundation