Intermediate Coronary Artery Lesion Successfully Treated with a Bioresorbable Vascular Scaffold

- Operator : Seung-Jung Park

Intermediate Coronary Artery Lesion Successfully Treated with a Bioresorbable Vascular Scaffold
- Operator: Seung-Jung Park, MD
Case Presentation
A 78 year-old gentleman was admitted for effort angina with abnormal coronary CT findings. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=61%) without regional wall motion abnormality. The thallium SPECT showed normal perfusion. The coronary CT showed diffuse intermediate stenosis of mLAD. His coronary risk factors were hypertension, ex-smoking.
Baseline Coronary Angiogram
  1. Left coronary angiogram showed intermediate diffuse 50% narrowing of mLAD with 0.79 of FFR during maximal hyperemia. ( Movie 1)
  2. A right coronary angiogram was normal. ( Movie 2)
Procedure
We decided to treat mid LAD intermediate stenotic lesion with a bioresorbable vascular scaffold. A 7 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 7 Fr JL 4.0 catheter with side hole. Firstly, we advanced Sion blue 0.014-inch guidewire into the LAD and evaluated plaque by IVUS. IVUS-derived Minimal lumen area was 2.35mm2 and plaque burden was 73.7% (Figure 1) and the proximal to the MLA site, there was a TCFA on OCT (Figure 2). NIRS-derived lipid burden detected a max LCBI 4mm of 413. (Figure 3) The mid LAD was predilated with 2.75mm x 15mm NC balloon at 24 atm. The mid LAD was then gently dilated with 3.0mm x 28mm BVS at 7 atm ( Movie 3) for a minute and post dilated with 3.0mm x 20mm NC balloon at 28 atm up to 3.25mm. Post PCI OCT image showed good coverage with 5.6mm2 MSA. (Figure 4) Final angiogram showed that the procedure was successful ( Movie 4).

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