Author + information
- Received May 8, 2017
- Revision received June 9, 2017
- Accepted June 12, 2017
- Published online September 18, 2017.
- Taishi Okuno, MDa,
- Kazuyuki Yahagi, MDa,
- Yu Horiuchi, MDa,
- Jiro Aoki, MDa,
- Charles A. Simonton, MDb,
- Richard Rapoza, PhDb,
- Shigeru Saito, MDc,
- Takeshi Kimura, MDd and
- Kengo Tanabe, MDa,∗ ()
- aDivision of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- bAbbott Vascular, Santa Clara, California
- cDivision of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan
- dDepartment of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
- ↵∗Address for correspondence:
Dr. Kengo Tanabe, Division of Cardiology, Coronary Intensive Care Unit, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
A 70-year-old man who was enrolled in the ABSORB EXTEND trial (1) underwent percutaneous coronary intervention with implantation of a 3.0 mm × 18.0 mm Absorb bioresorbable vascular scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California) for the de novo lesion in the mid–right coronary artery (Figures 1A and 1B). Optical coherence tomography (OCT) showed well-expanded Absorb BVS without strut fracture immediately after implantation (Figure 1C, a to d).
Follow-up angiography at 8 months demonstrated no restenosis at the BVS site (Figure 1D). OCT showed residual struts with preserved black box appearances that were completely apposed to the vessel and mostly covered with thin neointima (Figure 1E, a’ to d’). There was no evidence of scaffold fracture or discontinuity. He returned with unstable angina after 4 years following Absorb BVS implantation. Angiography demonstrated restenosis at the BVS site (Figure 1F). OCT showed excessive in-scaffold tissue growth with peristrut low-intensity area (PLIA) (Figure 1G, a” to d”).
Absorb BVS has emerged as a new device to overcome the long-term limitations of drug-eluting stents by the transient presence of scaffolds. In our case, OCT images at 4 years showed a couple of preserved black box appearances and excessive neointimal proliferation accompanied by PLIA, although there was no evidence of PLIA or restenosis at 8 months. Sato et al. (2) reported that PLIA following Absorb BVS implantation was associated with neointimal formation in OCT study. Pathologically, PLIA suggested peristrut inflammation or neovascularization (3). These mechanisms (inflammation or neovascularization) might be at play in this case of late restenosis.
Drs. Simonton and Rapoza are full-time employees of Abbott Vascular. Dr. Saito has received honorarium from Abbott Vascular Japan. Dr. Kimura is a member of the advisory board of and has received a research grant from Abbott Vascular. Dr. Tanabe is a member of the advisory board of has received honorarium from Abbott Vascular Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 8, 2017.
- Revision received June 9, 2017.
- Accepted June 12, 2017.
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