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Radial strength and expansion of scaffold struts remain a concern when considering a PCI with bioresorbable vascular scaffold
International Journal of Cardiology 191 (2015) 254–255
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Radial strength and expansion of scaffold struts remain a concern when considering a PCI with bioresorbable vascular scaffold Fabrizio D'Ascenzo 1, Antonio H. Frangieh 1, Christian Templin ⁎ University Hospital Zurich, University Hospital Zurich, Department of Cardiology, Switzerland
a r t i c l e
i n f o
Article history: Received 16 April 2015 Accepted 18 April 2015 Available online 8 May 2015 Keywords: Desolve Radial strength
We report about a 62 year old man, with a history of diabetes and previous percutaneous coronary intervention (PCI) of the right coronary artery. He was admitted at our division for staged PCI of a significant, mild calcified, type B2 lesion in the medial segment of the left anterior descending (LAD) (A-A″). Ejection fraction was preserved at ventriculography. After predilatation with a 3.0 × 15 mm noncompliant balloon (NCB) with 12 atm (nominal pressure), a 3.0 × 28 mm Novolimus-eluting bioresorbable coronary scaffold (BVS) (DESolve, Elixir Medical Corporation) was implanted up to 11 atm (3.11 mm as reference diameter with this pressure) and then postdilated with 3.0 × 15 mm NCB with 20 atm (3.18 mm) with acceptable angiographic result (Panel B). Optical Coherence Tomography (OCT) (Panel B′-B″, Supplementary Online, Videos) showed absence of dissection with good strut apposition but underexpansion in the mid part of the scaffold (minimum lumen area (MLA) of 3.23 mm2 in the stented segment), which improved only slightly at OCT control, after postdilation with another 3.5 × 12 mm NCB inflated up to 20 atm (3.50 mm; MLA of 3.35 mm2) (Panel C′-C″, Supplementary Online, Videos). Finally, a 3.5 × 34 mm Zotarolimus-eluting stent was implanted with 12 atm in the BVS (3.45 mm) (Panel D) and postdilated with 3.5 × 12 mm NCB with 20 atm (3.71 mm). Angiography and OCT pullback showed good result (MLA of 5.51 mm2) with no dissection or thrombus (Panels D′-D″, Supplementary Online, Videos). Drug-eluting BVS constitutes a promising innovation in the current era of interventional cardiology, with the advantage of complete resorption, restoration of endothelial function and providing the possibility of ⁎ Corresponding author at: University Hospital Zurich, University Heart Center, Department of Cardiology, Raemistr, 100, 8091 Zurich, Switzerland. E-mail address: [email protected] (C. Templin). 1 Contributed equally.
http://dx.doi.org/10.1016/j.ijcard.2015.04.148 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
performing additional surgical revascularization therapies in the treated segments [1]. Concerns about stent thrombosis, mainly due to malapposition of the scaffold struts [2], are lately addressed with technical deployment recommendations especially postdilatation with NCB. Nevertheless, this case shows that radial strength [3] and expansion of the scaffold are still a concern in some lesions and confirms once again the importance of OCT-guided BVS implantation in order to achieve better short and long-term results (3) See Fig. 1, panels.
B’
A
A
A
B
B
B
C
C
C
D
D
D
B’’
C’ C’’
D’ D’’
Fig. 1. Angiographic (left) and OCT (right) findings.
F. D'Ascenzo et al. / International Journal of Cardiology 191 (2015) 254–255
Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.04.148. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] D. Capodanno, T. Gori, H. Nef, A. Latib, J. Mehilli, M. Lesiak, G. Caramanno, C. Naber, C. Di Mario, A. Colombo, P. Capranzano, J. Wiebe, A. Araszkiewicz, S. Geraci, S. Pyxaras, A. Mattesini, T. Naganuma, T. Münzel, C. Tamburino, Percutaneous coronary
255
intervention with everolimus-eluting bioresorbable vascular scaffolds in routine clinical practice: early and midterm outcomes from the European Multicentre GHOST-EU Registry, EuroIntervention 10 (10) (Feb 2015) 1144–1153. [2] F. D'Ascenzo, M. Bollati, F. Clementi, D. Castagno, B. Lagerqvist, J.M. de la Torre Hernandez, J.M. ten Berg, B.R. Brodie, P. Urban, L.O. Jensen, G. Sardi, R. Waksman, J.M. Lasala, S. Schulz, G.W. Stone, F. Airoldi, A. Colombo, G. Lemesle, R.J. Applegate, P. Buonamici, A.J. Kirtane, A. Undas, I. Sheiban, F. Gaita, G. Sangiorgi, M.G. Modena, G. Frati, G. Biondi-Zoccai, Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses, Int. J. Cardiol. 167 (2) (Jul 31 2013) 575–584. [3] J.A. Ormiston, B. Webber, B. Ubod, O. Darremont, M.W. Webster, An independent bench comparison of two bioresorbable drug-eluting coronary scaffolds (Absorb and DESolve) with a durable metallic drug-eluting stent (ML8/Xpedition), EuroIntervention 11 (1) (May 2015) 60–67.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Radial strength and expansion of scaffold struts remain a concern when considering a PCI with bioresorbable vascular scaffold Fabrizio D'Ascenzo 1, Antonio H. Frangieh 1, Christian Templin ⁎ University Hospital Zurich, University Hospital Zurich, Department of Cardiology, Switzerland
a r t i c l e
i n f o
Article history: Received 16 April 2015 Accepted 18 April 2015 Available online 8 May 2015 Keywords: Desolve Radial strength
We report about a 62 year old man, with a history of diabetes and previous percutaneous coronary intervention (PCI) of the right coronary artery. He was admitted at our division for staged PCI of a significant, mild calcified, type B2 lesion in the medial segment of the left anterior descending (LAD) (A-A″). Ejection fraction was preserved at ventriculography. After predilatation with a 3.0 × 15 mm noncompliant balloon (NCB) with 12 atm (nominal pressure), a 3.0 × 28 mm Novolimus-eluting bioresorbable coronary scaffold (BVS) (DESolve, Elixir Medical Corporation) was implanted up to 11 atm (3.11 mm as reference diameter with this pressure) and then postdilated with 3.0 × 15 mm NCB with 20 atm (3.18 mm) with acceptable angiographic result (Panel B). Optical Coherence Tomography (OCT) (Panel B′-B″, Supplementary Online, Videos) showed absence of dissection with good strut apposition but underexpansion in the mid part of the scaffold (minimum lumen area (MLA) of 3.23 mm2 in the stented segment), which improved only slightly at OCT control, after postdilation with another 3.5 × 12 mm NCB inflated up to 20 atm (3.50 mm; MLA of 3.35 mm2) (Panel C′-C″, Supplementary Online, Videos). Finally, a 3.5 × 34 mm Zotarolimus-eluting stent was implanted with 12 atm in the BVS (3.45 mm) (Panel D) and postdilated with 3.5 × 12 mm NCB with 20 atm (3.71 mm). Angiography and OCT pullback showed good result (MLA of 5.51 mm2) with no dissection or thrombus (Panels D′-D″, Supplementary Online, Videos). Drug-eluting BVS constitutes a promising innovation in the current era of interventional cardiology, with the advantage of complete resorption, restoration of endothelial function and providing the possibility of ⁎ Corresponding author at: University Hospital Zurich, University Heart Center, Department of Cardiology, Raemistr, 100, 8091 Zurich, Switzerland. E-mail address: [email protected] (C. Templin). 1 Contributed equally.
http://dx.doi.org/10.1016/j.ijcard.2015.04.148 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
performing additional surgical revascularization therapies in the treated segments [1]. Concerns about stent thrombosis, mainly due to malapposition of the scaffold struts [2], are lately addressed with technical deployment recommendations especially postdilatation with NCB. Nevertheless, this case shows that radial strength [3] and expansion of the scaffold are still a concern in some lesions and confirms once again the importance of OCT-guided BVS implantation in order to achieve better short and long-term results (3) See Fig. 1, panels.
B’
A
A
A
B
B
B
C
C
C
D
D
D
B’’
C’ C’’
D’ D’’
Fig. 1. Angiographic (left) and OCT (right) findings.
F. D'Ascenzo et al. / International Journal of Cardiology 191 (2015) 254–255
Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.04.148. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] D. Capodanno, T. Gori, H. Nef, A. Latib, J. Mehilli, M. Lesiak, G. Caramanno, C. Naber, C. Di Mario, A. Colombo, P. Capranzano, J. Wiebe, A. Araszkiewicz, S. Geraci, S. Pyxaras, A. Mattesini, T. Naganuma, T. Münzel, C. Tamburino, Percutaneous coronary
255
intervention with everolimus-eluting bioresorbable vascular scaffolds in routine clinical practice: early and midterm outcomes from the European Multicentre GHOST-EU Registry, EuroIntervention 10 (10) (Feb 2015) 1144–1153. [2] F. D'Ascenzo, M. Bollati, F. Clementi, D. Castagno, B. Lagerqvist, J.M. de la Torre Hernandez, J.M. ten Berg, B.R. Brodie, P. Urban, L.O. Jensen, G. Sardi, R. Waksman, J.M. Lasala, S. Schulz, G.W. Stone, F. Airoldi, A. Colombo, G. Lemesle, R.J. Applegate, P. Buonamici, A.J. Kirtane, A. Undas, I. Sheiban, F. Gaita, G. Sangiorgi, M.G. Modena, G. Frati, G. Biondi-Zoccai, Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses, Int. J. Cardiol. 167 (2) (Jul 31 2013) 575–584. [3] J.A. Ormiston, B. Webber, B. Ubod, O. Darremont, M.W. Webster, An independent bench comparison of two bioresorbable drug-eluting coronary scaffolds (Absorb and DESolve) with a durable metallic drug-eluting stent (ML8/Xpedition), EuroIntervention 11 (1) (May 2015) 60–67.