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 70-year-old gentleman presented with effort angina. His coronary risk factors were hypertension, diabetes mellitusand ex-smoker. Sixteen years ago, he underwent PCI at proximal LAD (Crossflex 3.0×10mm). The physical examination was unremarkable. The ECG and cardiac enzymes were normal. The transthoracic echocardiography showed normal LV systolic function (EF=57%) without regional wall motion abnormality.

Baseline Coronary Angiography

Left coronary angiogram showed diffuse in-stent restenosis at proximal to mid LAD. ( Movie 1) Right coronary angiogram showed intermediate tubular narrowing at proximal RCA with 0.85 of FFR during maximal hyperemia. ( Movie 2)

Procedure

We decided to treat diffuse in-stent restenosis of mid LAD with a conventional drug eluting stent. For the intermediate lesion of mid RCA, we decided to evaluate the functional status with FFR and the plaque characteristics with various intravascular imaging. 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. The mLAD was fixed with 2.75mm x 15mm TREK NC balloon and Xience Alpine 3.0 x 38 mm stent was successfully deployed at distal LM to mid LAD (Figure 1). Then we moved on to the RCA lesion. FFR was measured 0.89 for maximal hyperemia under 140mcg/kg/min of IV adenosine. On the IVUS, minimal lumen area was 3.30mm2 and plaque burden was 78% (Figure 2). And at the proximal to the MLA site, there was a rupture on OCT (Figure 3) and max LCBI4mm was checked 371 on NIRS. (Figure 4). For the vulnerable features of the plaque, we decide to fix the RCA lesion with bioaresorbable vascular scaffolds. Firstly, the lesion was predilated with 4.0mm x 20mm Pantera LEO balloon for several times. Then, proximal RCA was then gently dilated with 3.5mm x 28mm ABSORB for a minute and postdilated with 4.0mm x 20mm Pantera LEO balloon (Figure 5). Post PCI OCT image showed good coverage (Figure 6). Final right angiogram showed that the procedure was successful ( Movie 3).