Author + information
- Akihito Tanaka, MD∗ (, )
- Richard J. Jabbour, MD,
- Hiroyoshi Kawamoto, MD,
- Azeem Latib, MD and
- Antonio Colombo, MD
- ↵∗EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy
A 65-year-old man with stable angina underwent percutaneous coronary intervention with a 3.0 × 18-mm bioresorbable scaffold (BRS) type 1 (DESolve, Elixir Medical Corp., Sunnyvale, California) in the mid-left anterior descending artery, followed by a 2.5 × 28-mm BRS type 2 (Absorb, Abbott Vascular, Santa Clara, California) to cover a distal edge dissection because another BRS type 1 could not pass distally. The final angiographic result was excellent (Figures 1A and 1B).
After 10 months, the patient presented with a recurrence of his anginal symptoms and underwent repeat coronary angiography. There was angiographic evidence of a significant restenosis at the overlapping site and throughout the BRS type 1 (Figure 1C). Optical coherence tomography (OCT) was performed and revealed significant neointimal hyperplasia at the sites. Furthermore, multiple overhung struts (discontinuities or strut fractures) were observed in BRS type 1; however, no discontinuity was present with BRS type 2 (Figures 1D to 1H).
Several types of BRS are in development (1), of which BRS type 1 and type 2 are the first 2 BRSs approved by the Conformité European mark for use in coronary artery disease. They have different bioresorption times: BRS type 2 completely resorbs within 3 years and BRS type 1 within 2 years. Late discontinuity is considered part of the normal bioresorption process (2) and is presumed to occur at different times as resorption rates vary between BRSs.
In this case, OCT was not performed at the index procedure; therefore, we were unsure whether the overhung struts were late discontinuities or strut fractures formed at the index procedure. If the latter is true, this could account for the difference in restenosis between the 2 types of scaffold. Furthermore, the overlapping site developed the most severe in-scaffold restenosis, which suggests that overlapping current-generation BRS, which have very thick struts, should be avoided and preference given to an abutting scaffold to scaffold strategy.
This case uniquely illustrates the differences in resorption process between the 2 commercially available BRS implanted in the same vessel.
Please note: Dr. Latib serves on the advisory board for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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