- Email: [email protected]
Persistent Bioresorbable Vascular Scaffold by Optical Coherence Tomography Imaging at 5 Years
JACC: CARDIOVASCULAR INTERVENTIONS
VOL.
ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
-, NO. -, 2017
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jcin.2016.11.008
IMAGES IN INTERVENTION
Persistent Bioresorbable Vascular Scaffold by Optical Coherence Tomography Imaging at 5 Years Noriaki Moriyama, MD, Koki Shishido, MD, Kazuki Tobita, MD, Takuma Takada, MD, Tomoki Ochiai, MD, Saori Tsukuda, MD, Futoshi Yamanaka, MD, Kazuya Sugitatsu, MD, Shingo Mizuno, MD, Yutaka Tanaka, MD, PHD, Masato Murakami, MD, PHD, Junya Matsumi, MD, Saeko Takahashi, MD, Takeshi Akasaka, MD, PHD, Shigeru Saito, MD
A
-74-year-old ABSORB
man
EXTEND
included Clinical
in
the
Investigation
(NCT01023789) underwent percutaneous cor-
Absorb BVS1.1 (Figures 2A and 2B). Additionally, a part of
intima
on
“black
box”
was
disconnected
(Figure 2C).
onary intervention with an everolimus-eluting bio-
In previous studies, mean intimal thickness was
resorbable vascular scaffold (BVS) (Absorb BVS1.1,
over than thickness of BVS at 6 months (1); further-
Abbot Vascular, Santa Clara, California) 3.0 18 mm
more, the struts were no longer discernable at 5 years
in proximal right coronary artery for stable angina.
by OCT (2,3). In contrast, “black box” structures,
After post-dilation at high pressure (20 atm) with
which had same configuration and thickness as the
3.25 mm noncompliant balloon, an excellent angio-
BVS, were confirmed in this case at 5 years. It has
graphic result was obtained. Final optical coherence
been speculated that abnormal strut resorption pro-
;tomography (OCT) imaging revealed adequate appo-
cess might be participated. OCT finding at 1 year
sition and symmetrical expansion (Figures 1A to 1C).
showed unusual insufficient intimal growth only at
Serial OCT imaging follow-up at 1 and 5 years was
the distal end of scaffold. Delayed BVS endotheliali-
performed. At 1 year, OCT detected neointimal
zation might be one of the factors for abnormal
coverage for the most part of strut with “black box”
resorption process. Here, we show the first case of
appearance. However, neointimal thickness at the
incomplete absorption for BVS at 5 years. This finding
distal portion of BVS was significantly thinner than
should be investigated to figure out resorption
other portions (Figures 1D to 1F and 1D’ to 1F’).
process of BVS in greater detail.
At 5 years after implantation, OCT confirmed nearly complete scaffold resorption in the proximal seg-
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
ments but “black box” objectives remained visible
Noriaki Moriyama, Department of Cardiology and
at the distal end of BVS (Figures 1G to 1I). It looked like
Catheterization Laboratory, Shonan Kamakura Gen-
the empty shell of a scaffold that was 140 to 150 m m
eral Hospital, 1370-1 Okamoto, Kamakura, Kanagawa
thick. It was exactly equivalent to the thickness of
247-8533, Japan. E-mail: [email protected].
From the Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received August 31, 2016; revised manuscript received October 27, 2016, accepted November 3, 2016.
e2
Moriyama et al. Visualization of Scaffold Remnants by OCT at 5 Years
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
-, NO. -, 2017 - 2017:e-–-
F I G U R E 1 Angiographic Observations After BVS Implantation
(1 to 3) Serial angiographic observations after bioresorbable vascular scaffold (BVS) implantation at the 1- and 5-year follow-up. Optical coherence tomography (OCT) images at matched sites (A, D, G, scaffold proximal end; B, E, H, right ventricular branch; C, F, I, distal end). Note the complete resolution of good apposition at post-implantation in A to C. Sufficient intimal coverage at 1 year in D and E with the exception of scaffold distal end in F. D’ to F’ are magnified figures in panels D to F. At 5-year follow-up, BVS was invisible by OCT in G and H. The sites previously occupied by polymeric struts have preserved black box appearance on the 5-year OCT images in I. GW ¼ guidewire; LAO ¼ left anterior oblique; RAO ¼ right anterior oblique; RVB ¼ right ventricular branch.
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
-, NO. -, 2017
- 2017:e-–-
Moriyama et al. Visualization of Scaffold Remnants by OCT at 5 Years
F I G U R E 2 OCT Images at Distal End of Scaffold in 5-Year Follow-Up
(A) The sites previously occupied by polymeric struts have preserved black box appearance. (B and C) Thickness of the objects (white bar), which is same as that of BVS1.1. (C) Disconnected intima (white arrow).
REFERENCES 1. Bourantas CV, Farooq V, Zhang Y, Muramatsu T, et al. Circumferential distribution of the neointima at six-month and two-year follow-up after a bioresorbable vascular scaf-
2. Serruys PW, Ormiston J, van Geuns RJ, et al. A polylactide bioresorbable scaffold eluting everolimus for treatment of coronary stenosis: 5-year follow-up. J Am Coll Cardiol 2016;67:766–76.
bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities. EuroIntervention 2016;11:996–1003.
fold implantation: a substudy of the ABSORB Cohort B Clinical Trial. EuroIntervention 2015;10: 1299–306.
3. Simsek C, Karanasos A, Magro M, et al. Longterm invasive follow-up of the everolimus-eluting
KEY WORDS bioresorbable vascular scaffold, optical coherence tomography
e3
VOL.
ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
-, NO. -, 2017
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jcin.2016.11.008
IMAGES IN INTERVENTION
Persistent Bioresorbable Vascular Scaffold by Optical Coherence Tomography Imaging at 5 Years Noriaki Moriyama, MD, Koki Shishido, MD, Kazuki Tobita, MD, Takuma Takada, MD, Tomoki Ochiai, MD, Saori Tsukuda, MD, Futoshi Yamanaka, MD, Kazuya Sugitatsu, MD, Shingo Mizuno, MD, Yutaka Tanaka, MD, PHD, Masato Murakami, MD, PHD, Junya Matsumi, MD, Saeko Takahashi, MD, Takeshi Akasaka, MD, PHD, Shigeru Saito, MD
A
-74-year-old ABSORB
man
EXTEND
included Clinical
in
the
Investigation
(NCT01023789) underwent percutaneous cor-
Absorb BVS1.1 (Figures 2A and 2B). Additionally, a part of
intima
on
“black
box”
was
disconnected
(Figure 2C).
onary intervention with an everolimus-eluting bio-
In previous studies, mean intimal thickness was
resorbable vascular scaffold (BVS) (Absorb BVS1.1,
over than thickness of BVS at 6 months (1); further-
Abbot Vascular, Santa Clara, California) 3.0 18 mm
more, the struts were no longer discernable at 5 years
in proximal right coronary artery for stable angina.
by OCT (2,3). In contrast, “black box” structures,
After post-dilation at high pressure (20 atm) with
which had same configuration and thickness as the
3.25 mm noncompliant balloon, an excellent angio-
BVS, were confirmed in this case at 5 years. It has
graphic result was obtained. Final optical coherence
been speculated that abnormal strut resorption pro-
;tomography (OCT) imaging revealed adequate appo-
cess might be participated. OCT finding at 1 year
sition and symmetrical expansion (Figures 1A to 1C).
showed unusual insufficient intimal growth only at
Serial OCT imaging follow-up at 1 and 5 years was
the distal end of scaffold. Delayed BVS endotheliali-
performed. At 1 year, OCT detected neointimal
zation might be one of the factors for abnormal
coverage for the most part of strut with “black box”
resorption process. Here, we show the first case of
appearance. However, neointimal thickness at the
incomplete absorption for BVS at 5 years. This finding
distal portion of BVS was significantly thinner than
should be investigated to figure out resorption
other portions (Figures 1D to 1F and 1D’ to 1F’).
process of BVS in greater detail.
At 5 years after implantation, OCT confirmed nearly complete scaffold resorption in the proximal seg-
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
ments but “black box” objectives remained visible
Noriaki Moriyama, Department of Cardiology and
at the distal end of BVS (Figures 1G to 1I). It looked like
Catheterization Laboratory, Shonan Kamakura Gen-
the empty shell of a scaffold that was 140 to 150 m m
eral Hospital, 1370-1 Okamoto, Kamakura, Kanagawa
thick. It was exactly equivalent to the thickness of
247-8533, Japan. E-mail: [email protected].
From the Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received August 31, 2016; revised manuscript received October 27, 2016, accepted November 3, 2016.
e2
Moriyama et al. Visualization of Scaffold Remnants by OCT at 5 Years
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
-, NO. -, 2017 - 2017:e-–-
F I G U R E 1 Angiographic Observations After BVS Implantation
(1 to 3) Serial angiographic observations after bioresorbable vascular scaffold (BVS) implantation at the 1- and 5-year follow-up. Optical coherence tomography (OCT) images at matched sites (A, D, G, scaffold proximal end; B, E, H, right ventricular branch; C, F, I, distal end). Note the complete resolution of good apposition at post-implantation in A to C. Sufficient intimal coverage at 1 year in D and E with the exception of scaffold distal end in F. D’ to F’ are magnified figures in panels D to F. At 5-year follow-up, BVS was invisible by OCT in G and H. The sites previously occupied by polymeric struts have preserved black box appearance on the 5-year OCT images in I. GW ¼ guidewire; LAO ¼ left anterior oblique; RAO ¼ right anterior oblique; RVB ¼ right ventricular branch.
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
-, NO. -, 2017
- 2017:e-–-
Moriyama et al. Visualization of Scaffold Remnants by OCT at 5 Years
F I G U R E 2 OCT Images at Distal End of Scaffold in 5-Year Follow-Up
(A) The sites previously occupied by polymeric struts have preserved black box appearance. (B and C) Thickness of the objects (white bar), which is same as that of BVS1.1. (C) Disconnected intima (white arrow).
REFERENCES 1. Bourantas CV, Farooq V, Zhang Y, Muramatsu T, et al. Circumferential distribution of the neointima at six-month and two-year follow-up after a bioresorbable vascular scaf-
2. Serruys PW, Ormiston J, van Geuns RJ, et al. A polylactide bioresorbable scaffold eluting everolimus for treatment of coronary stenosis: 5-year follow-up. J Am Coll Cardiol 2016;67:766–76.
bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities. EuroIntervention 2016;11:996–1003.
fold implantation: a substudy of the ABSORB Cohort B Clinical Trial. EuroIntervention 2015;10: 1299–306.
3. Simsek C, Karanasos A, Magro M, et al. Longterm invasive follow-up of the everolimus-eluting
KEY WORDS bioresorbable vascular scaffold, optical coherence tomography
e3