Author + information
- Received September 19, 2016
- Accepted September 22, 2016
- Published online January 2, 2017.
- Felix Meincke, MDa,∗ (, )
- Claudia Reinholz, MDa,
- Tobias Spangenberg, MDa,
- Hendrik Wienemann, MDa,
- Aref Arjomand, MDa,
- Felix Kreidel, MDa,
- Karl-Heinz Kuck, MDa and
- Alexander 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, Online Video 1). 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, Online Video 2).
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.
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 September 19, 2016.
- Accepted September 22, 2016.
- American College of Cardiology Foundation