Author + information
- Received May 28, 2018
- Accepted June 5, 2018
- Published online September 26, 2018.
- Piera Capranzano, MDa,∗ (, )
- Bruno Francaviglia, MDb,
- Maria D. Radu, MD, PhDb,
- Davide Capodanno, MD, PhDa,
- Maria Elena Di Salvo, MDa and
- Corrado Tamburino, MD, PhDa
- aCardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
- bThe Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Piera Capranzano, University of Catania, Italy, Cardiology Division, CAST Policlinico Hospital, S. Sofia, 95123 Catania, Italy.
A 65-year-old man with non–ST-segment elevation myocardial infarction underwent implantation of two 3.0 × 28-mm Absorb bioresorbable vascular scaffolds (BVS) (Abbott Vascular, Santa Clara, California), in a large obtuse marginal branch. Post-procedural optical coherence tomography (OCT) showed complete strut apposition, good scaffold expansion, and absence of fracture. The underlying vessel wall showed signs of a plaque prolapsing with a bright luminal aspect and high signal attenuation (Figure 1A), suggestive of fibroatheroma, possibly with macrophages and a discontinuity of the luminal contour.
Planned OCT 4.6 years later demonstrated complete scaffold resorption, with good lumen area (mean 5.4 mm2). Comparison between baseline (Figures 1A and 1A′) and 4.6-year (Figures 1B and 1B′) OCT showed an apparent change in the described eccentric plaque with marked reduction in the light attenuation, suggesting a considerable modification in the overall lipid content. Inspection of the luminal contour—which at follow-up corresponded to the neointimal layer on top of the BVS—showed a homogenous, signal-rich tissue in the majority of the circumference except at 8 to 10 o’clock, where a superficial line with bright signal and abluminal transparent shadowing (Figure 1B) could be seen. The former is indicative of a fibrous neointimal layer, whereas the latter suggests macrophage accumulation.
Although the changes in optical properties in the underlying plaque of BVS could suggest plaque passivation, it remains unclear whether the neointimal macrophages infiltration represents a lower inflammatory grade of neoatherosclerosis, or merely the general scavenging function of those cells. To our knowledge, this is the first report on late fibroatheroma modification after BVS, highlighting the importance of further exploring the possible therapeutic benefits of absorbable scaffolds and stents, in terms of plaque modification and vessel healing at long term.
Dr. Radu has received speakers honoraria from St. Jude Medical and Abbott. Dr. Tamburino has received honoraria/lecture fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2018.
- Accepted June 5, 2018.
- 2018 American College of Cardiology Foundation