Author + information
- Elisabetta Moscarella1,
- Alfonso Ielasi2,
- Bernardo Cortese Cortese3,
- Maria Carmen De Angelis4 and
- Attilio Varricchio4
Patient initials or identifier number
Relevant clinical history and physical exam
In June 2012, a 74 years old man, with risk factors notable for hypertension, hypercholesterolemia and current smoker, presented with non-ST elevation myocardial infarction (NSTEMI). Coronary angiography showed a severe stenosis on right coronary artery treated with percutaneous coronary intervention (PCI) with three DES implantation. Echocardiography showed maintained ejection fraction (EF) and he discharged after three days in good clinical conditions.
Relevant test results prior to catheterization
In December 2012, he admitted to our institution with a novel NSTEMI, echocardiography showed akinesia of the inferior wall with depressed EF 45%.
Relevant catheterization findings
Angiography revealed critical DES ISR that was treated, after lesion predilatation, with the implantation of a 3.5 x 28 mm BVS deployed through a standard stepwise balloon dilation (2 atm every 5″up to a 30″inflation up to 14 atm), post dilated with a 4.0 x 20 mm non-compliant balloon.
At six-months, follow-up scheduled angiography showed good angiographic results. Intracoronary imaging with optical coherence tomography (OCT, St. Jude Medical, St.Paul MN) was performed confirming good result with complete struts rehendotelization and a maximum strut incomplete apposition of 0.14 mm that was left untreated. After 45 months, the patient was asymptomatic, on aspirin mono-therapy and underwent further angiographic control that showed a persistent good result with complete struts resorption with only a few dissolved black box still present, representing an advanced degree of struts degradation.
Recently, attention focused on the use of BVS as an alternative option to DES or drug eluting balloon for ISR treatment.Despite representing an off-label indication, BVS used in ISR have shown good results even on the long-term follow-up. When used in de novo coronary lesions, BVS is expected to fully resorb in 3-4 years, however, to date, there is no evidence of complete BVS resorption when used in ISR lesions.
To the best of our knowledge, we report the first comprehensive intracoronary imaging report, showing complete BVS resorption after ISRtreatment, confirming that BVS might be considered as an alternative “no-struts behind” ISR treatment option.