Coronary artery aneurysm after implantation of a bioresorbable vascular scaffold: Case report and literature review

A 55‐year‐old man underwent successful percutaneous coronary intervention for the middle left circumflex artery with a 3.5 × 28‐mm bioresorbable vascular scaffold (BVS). At 18 months, follow‐up coronary angiography showed ectatic change with aneurysm formation over the BVS. Optical coherence tomography revealed absence of strut continuity at the aneurysm site, in the middle of the BVS. A literature review identified nine patients with intrascaffold aneurysm, including the present patient, which developed 6–32 months after BVS implantation. Of these nine patients, four underwent percutaneous coronary intervention for chronic total occlusion. The pathogenesis of coronary artery aneurysm is multifactorial. Most patients receive no further intervention, but long‐term dual antiplatelet therapy is sometimes prescribed in conjunction with regular follow‐up. © 2017 Wiley Periodicals, Inc.     

Delivery of a bioresorbable vascular scaffold to complex lesions

The use of bioresorbable vascular scaffolds (BVS) in percutaneous coronary interventions holds great promise and the Absorb® BVS is increasingly used in clinical practice outside of controlled studies. However, questions have been raised concerning the delivery of the scaffold to complex lesions. We describe a case of successful delivery and implantation of two overlapping Absorb® BVS to a complex lesion in the left anterior descending artery. The crossing of the lesions was uneventful and after implantation a good acute result could be documented. A follow‐up angiogram after 3 months proofed a stable midterm result. We thereby demonstrate the feasibility of delivering Absorb® BVS to more complex lesions than practiced so far in the setting of clinical trials. © 2013 Wiley Periodicals, Inc.     

Coronary artery spasm treated with intracoronary bioresorbable scaffold implantation under the guidance of treadmill test and optical coherence tomography: A case report

Coronary artery spasm (CAS) can cause unstable angina, and the treatment of this disease is controversial. We report an elderly male patient who was admitted to hospital due to chest tightness. CAG showed that 70% stenosis in the middle of the right coronary artery (RCA). A bioresorbable scaffold (BRS) was implanted in the lesion under the guidance of optical coherence tomography (OCT). One year later, the patient's symptoms were relieved. The repeated CAG showed that the stent was good. BRS implantation under the guidance of treadmill test and OCT is one of treatment options for CAS patients.     

Proximal and distal maximal luminal diameters as a guide to appropriate deployment of the ABSORB everolimus‐eluting bioresorbable vascular scaffold

Objectives : Due to the limited distensibility of the everolimus‐eluting bioresorbable vascular scaffold (ABSORB) compared to metallic platform stents, quantitative coronary arteriography (QCA) is a mandatory requirement for ABSORB deployment in the on‐going ABSORB EXTEND Single‐Arm Study. Visual assessment of vessel size in the ABSORB Cohort B study often lead to under and over‐sizing of the 3 mm ABSORB in coronary vessels (recommended range of the vessel diameter ≥2.5 mm and ≤3.3 mm), with an increased risk of spontaneous incomplete scaffold apposition post ABSORB deployment. We report whether mandatory QCA assessment of vessel size pre‐implantation, utilizing the maximal luminal diameter (Dmax) and established interpolated reference vessel diameter (RVD) measurements, has improved device/vessel sizing. Methods : Pre‐implantation post‐hoc QCA analyses of all 101 patients from ABSORB Cohort B (102 lesions) and first consecutive 101 patients (108 lesions) from ABSORB EXTEND were undertaken by an independent core‐laboratory; all patients had a 3 mm ABSORB implanted. Comparative analyses were performed. Results : Within ABSORB Cohort B, a greater number of over‐sized vessels (>3.3 mm) were identified utilizing the Dmax compared to the interpolated RVD (17 vessels, 16.7% vs. 3 vessels, 2.9%; P = 0.002). Comparative analyses demonstrated a greater number of appropriate vessel‐size selection (75 vessels, 69.4% vs. 48 vessels, 47.1%; P = 0.001), a trend towards a reduction in implantation in small (<2.5 mm) vessels (29 vessels, 26.9% vs. 40 vessels, 39.2%; P = 0.057) and a significant decrease in the implantation in large (>3.3 mm) vessels (4 vessels, 3.7% vs. 17 vessels, 16.7%; P = 0.002) in ABSORB EXTEND. Bland–Altman plots suggested a good agreement between operator and core‐laboratory calculated Dmax measurements. Conclusions : The introduction of mandatory Dmax measurements of vessel size prior to ABSORB implantation significantly reduced the under‐sizing of the 3.0 mm scaffold in large vessels validating the use of this technique in vessel sizing prior to ABSORB implantation. © 2011 Wiley Periodicals, Inc.     

The ABSORB bioresorbable vascular scaffold: A novel,fully resorbable drug‐eluting stent: Current concepts and overview of clinical evidence

The advent of fully bioresorbable stent technology and specifically the ABSORB?, a bioresorbable vascular scaffold (BVS) stent, is heralded as breakthrough technology in the current era of percutaneous coronary interventions. This article reviews the current understanding of this technology along with the clinical evidence from trials and registries of ABSORB BVS that included patients with both simple as well as more complex “real‐world” coronary lesions. In addition, considering the current limitations of this device—mostly associated with the mechanical properties of the polymeric scaffold structure—a review of guidelines on successful implantation of the ABSORB BVS is presented. Although expert feedback suggests extensive use of this device in routine clinical practice outside the United States despite a paucity of data on long‐term safety in this setting, attention to procedural details and implantation technique is obligatory to achieve optimal clinical outcomes. © 2015 Wiley Periodicals, Inc.     

生物可吸收支架Firesorb首次用于人体治疗冠心病的安全性和可行性:四年临床随访结果

目的报道置入生物可吸收支架Firesorb的患者术后4年的随访结果。方法本研究为FUTURE I研究的4年随访结果。FUTURE I研究是一项评估Firesorb支架治疗冠状动脉狭窄病变的可行性、初步安全性和有效性的前瞻性、单中心、非盲法的首次人体试验。2016年1至3月在阜外医院入选原发、原位、单支、单处冠状动脉狭窄病变患者45例。成功置入Firesorb支架后,以2∶1比例随机分为队列1(n=30)和队列2(n=15)。队列1患者在支架置入术后6个月、2年时进行冠状动脉造影、血管内超声(IVUS)、光学相干断层成像(OCT)检查,队列2患者在术后1、3年时进行上述检查。所有纳入患者在支架置入术后1、6个月及1、2、3、4、5年时进行临床随访。研究主要终点为术后1个月靶病变失败(TLF,包括心原性死亡、靶血管心肌梗死、缺血驱动的靶病变血运重建),次要终点包括患者相关临床复合终点(PoCE,包括全因死亡、所有的心肌梗死、所有的血运重建事件)。结果本研究共纳入45例成功置入Firesorb支架患者,年龄为(54.4±9.3)岁,其中男性35例(77.8%)。随访4年时队列1中10例患者复查了冠状动脉造影及OCT检查,其中2例患者置入的支架已经完全降解吸收,其他8例患者与队列2中患者3年时的OCT图像比较,支架降解程度增加,未见任何支架贴壁不良。4年临床随访率为100%。45例患者中有2例发生了PoCE事件(4.4%),其中1例患者术后第1天发生了非靶血管心肌梗死、非靶血管血运重建,并且于术后2年再次发生靶血管非靶病变血运重建;另1例患者于复查冠状动脉造影时进行了非缺血驱动的靶病变血运重建。4年随访期间无TLF、明确或可能的支架内血栓事件。结论在置入Firsorb支架术后4年时部分患者可出现支架的完全降解吸收。Firesorb支架治疗简单冠状动脉病变安全、有效。