Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain.
Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.
Catheter Cardiovasc Interv. 2019 Jan 1;93(1):79-81. doi: 10.1002/ccd.27871. Epub 2018 Sep 23.
Resorbable Magnesium Scaffolds (RMS) represent an interesting alternative to current drug-eluting stents. Current data from clinical trials seems to confirm good performance of these new devices with low rates of late device failure. Little is known about mechanisms leading to RMS failure. Herein, we present the first description of an early RMS in-scaffold restenosis. Optical coherence tomography (OCT) analysis at implantation detected acute non-severe malapposition and underexpansion as main promoters of RMS failure. OCT during in-scaffold restenosis intervention confirmed early severe neointimal proliferation and RMS late recoil and dismantling as the main mechanisms of device failure. We hypothesize that the fast resorption process of RMS may lead to an early loss of radial strength, that could favor late recoil, acquired underexpansion, device dismantling and might interact with distribution of sirolimus. This case also illustrates that OCT is pivotal to unravel both acute and acquired mechanisms related to RMS failure.
可吸收镁支架（RMS）是目前药物洗脱支架的一种很有前途的替代品。目前临床试验的数据似乎证实了这些新型器械具有良好的性能，晚期器械失败的发生率较低。但是，导致 RMS 失败的机制知之甚少。本文首次描述了一种早期 RMS 支架内再狭窄。植入时的光学相干断层扫描（OCT）分析发现急性非严重贴壁不良和扩张不足是 RMS 失败的主要原因。在支架内再狭窄介入期间进行的 OCT 检查证实了早期严重的新生内膜增殖以及 RMS 晚期的回缩和解体是器械失败的主要机制。我们假设 RMS 的快速吸收过程可能导致早期丧失径向强度，从而导致晚期回缩、获得性扩张不足、器械解体，并可能与西罗莫司的分布相互作用。该病例还表明，OCT 对于揭示与 RMS 失败相关的急性和获得性机制至关重要。
