Mitomo Satoru, Tanaka Akihito, Candilio Luciano, Azzalini Lorenzo, Carlino Mauro, Latib Azeem, Colombo Antonio
Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Cardiol Cases. 2018 Jan 2;17(4):126-129. doi: 10.1016/j.jccase.2017.12.003. eCollection 2018 Apr.
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. < 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.>.
一名55岁男性因左前降支慢性完全闭塞接受经皮冠状动脉介入治疗（PCI）。在用非顺应性（NC）球囊进行病变预处理后，植入了两枚生物可吸收血管支架（2.5/28 mm、3.0/28 mm，Absorb BVS，雅培血管，美国加利福尼亚州圣克拉拉），随后在20个大气压下用尺寸为1:1的NC球囊进行后扩张。最终血管内超声（IVUS）显示在弥漫性钙化病变中生物可吸收血管支架扩张良好。21个月的随访冠状动脉造影显示严重再狭窄，远端生物可吸收血管支架远端边缘再次闭塞。在用1.0 mm球囊再通后，进行了光学相干断层扫描（OCT）。在初次手术时对OCT和IVUS进行定量分析表明，随访时支架最小面积显著变小且偏心度更高，提示在有厚钙斑的病变处有严重回缩，而在钙化相对较薄的病变处未观察到这些变化。病变通过药物洗脱支架成功实现血运重建，最终OCT显示金属支架对称扩张。我们的病例表明，不同类型的钙化可对生物可吸收血管支架的扩张和回缩产生影响。在钙化病变中，必须采用最佳植入技术以获得最佳结果，而通过血管内成像对钙化病变进行特征描述可能有助于决定使用生物可吸收血管支架的PCI策略。<钙化病变对于生物可吸收血管支架（BVS）来说是具有挑战性的病变亚组，因为后者的径向支撑力较小。血管内成像的定量分析表明，不同类型的钙化可对生物可吸收血管支架的扩张和回缩产生影响。在钙化病变中，必须采用最佳植入技术以获得最佳结果，而通过血管内成像对钙化病变进行特征描述可能有助于决定使用生物可吸收血管支架的经皮冠状动脉介入治疗策略。>
