Different behaviors of bioresorbable vascular scaffold in different types of calcified lesion: Insights from intravascular imaging

Satoru Mitomo, Akihito Tanaka, Luciano Candilio, Lorenzo Azzalini, Mauro Carlino, Azeem Latib, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

A 55-year-old male underwent percutaneous coronary intervention (PCI) for left anterior descending artery chronic total occlusion. After lesion preparation with non-compliant (NC) balloon, two bioresorbable vascular scaffolds (2.5/28 mm, 3.0/28 mm, Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) were implanted followed by 1:1 sized NC balloon post-dilatation at 20 atm. Final intravascular ultrasound (IVUS) showed acceptable BVS expansion in diffusely calcified lesions. Twenty-one months’ follow-up coronary angiography revealed severe restenosis with reocclusion at the distal edge of the distal BVS. After recanalization with a 1.0 mm balloon, optical coherence tomography (OCT) was performed. Quantitative analysis comparing OCT and IVUS at the index procedure demonstrated that minimum scaffold area at follow-up became significantly smaller and with higher eccentricity, suggesting severe recoil at the lesions with thick calcium spot, whereas these changes were not observed at the lesion with relatively thin calcification. The lesions were successfully revascularized with drug-eluting stents and final OCT showed symmetric expansion of metallic stents. Our case demonstrates that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide PCI strategy with BVS. <Learning objective: Calcified lesions represent a challenging lesion subset for bioresorbable vascular scaffold (BVS) because of less radial strength of the latter. Quantitative analysis with intravascular imaging demonstrated that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide percutaneous coronary intervention strategy with BVS.>

Original languageEnglish (US)
Pages (from-to)126-129
Number of pages4
JournalJournal of Cardiology Cases
Volume17
Issue number4
DOIs
StatePublished - Apr 2018
Externally publishedYes

Keywords

  • Bioresorbable vascular scaffold
  • Calcified lesion
  • Intravascular ultrasound
  • Optical coherence tomography
  • Recoil

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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