JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 7, NO. 10, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2014.04.022
IMAGES IN INTERVENTION
One-Year Follow-Up Optical Coherence Tomography After Implantation of Bioresorbable Vascular Scaffolds for a Chronic Coronary Total Occlusion Toru Naganuma, MD,*yz Azeem Latib, MD,*y Vasileios F. Panoulas, MD,*yx Katsumasa Sato, MD,*y Tadashi Miyazaki, MD,*y Sunao Nakamura, MD,z Antonio Colombo, MD*y
A
coronary
One-year follow-up angiography showed excellent
angiography because of worsening angina,
results in BVS-treated segments (Figure 2B). Optical
70-year-old
male
underwent
which demonstrated proximal left anterior
coherence tomography (OCT) demonstrated accept-
descending coronary artery (LAD) chronic total occlu-
able scaffold and lumen areas with homogeneous
sion (CTO) collateralized by septal branches from the
neointimal hyperplasia similar to the one reported
right coronary artery and an antegrade bridge
in the context of non-CTO lesions (1). Furthermore,
(Figure 1A). The lesion was penetrated using retro-
there was no evidence of intraluminal masses. The
grade subintimal tracking (Figure 1B). Intravascular
patient remained on dual antiplatelet therapy since
ultrasound (IVUS) after pre-dilation with a 2.5-mm
his index procedure. Of note, partial strut malap-
balloon demonstrated that the retrograde guidewire
position was noted on OCT that may be possibly due
entered into subintimal space because of calcification
to: 1) absorption of hematoma or thrombus; 2) late
(Figure 1C, a and b). The re-entry point to the true
scaffold recoil; and/or 3) low sensitivity of IVUS to
lumen was distal to the LAD ostium (Figure 1C, c). A
assess for strut malapposition as compared with OCT.
total of 2 bioresorbable vascular scaffolds (BVS)
This case suggests the feasibility of BVS use in a CTO
(Abbott
lesion as well as its efficacy up to 1-year follow-up.
Vascular,
Santa
Clara,
California)
were
implanted without scaffold overlap, followed by post-dilation with a 3.25-mm noncompliant balloon.
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
Post-procedural IVUS showed well-expanded BVS
Antonio Colombo, Cardiac Catheterization Labora-
within the subintimal space and a collapsed true
tory, EMO-GVM Centro Cuore Columbus, 48 Via M.
lumen (Figure 2A, a–e). At that time, there was no
Buonarroti,
evidence of strut malapposition.
emocolumbus.it.
20145
Milan,
Italy.
From the *Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; yInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; zInterventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan; and xImperial College London, National Heart and Lung Institute, London, United Kingdom. Dr. Latib is on the advisory board of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received April 7, 2014; accepted April 10, 2014.
E-mail:
info@
e158
Naganuma et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014
Follow-Up OCT After Treatment of CTO With BVS
OCTOBER 2014:e157–9
F I G U R E 1 Coronary Angiography and IVUS Showing Retrograde Subintimal Tracking
A 70-year-old male underwent coronary angiography demonstrating a proximal LAD CTO. The lesion was penetrated using retrograde subintimal tracking technique. IVUS after pre-dilation with a 2.5-mm balloon demonstrated that the retrograde guidewire entered into subintimal space. (A) Initial angiography showing proximal LAD CTO (arrows) collateralized by septal branches from the right coronary artery and an antegrade bridge. (B) Successful retrograde subintimal tracking. (C) IVUS after pre-dilation with a 2.5-mm balloon demonstrating that the retrograde guidewire entered into subintimal space due to calcification. (a) IVUS catheter placed in the subintimal space, surrounded by hematoma (arrowheads). (b) IVUS catheter placed in the subintimal space, outside of calcification (Calc.). (c) IVUS longitudinal view showing that the re-entry point was distal to LAD ostium. CTO ¼ chronic total occlusion; IVUS ¼ intravascular ultrasound; LAD ¼ left anterior descending coronary artery; LCX ¼ left circumflex coronary artery; TL ¼ true lumen.
Naganuma et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014 OCTOBER 2014:e157–9
Follow-Up OCT After Treatment of CTO With BVS
F I G U R E 2 IVUS Images at the End of the Index Procedure and OCT Images at 1-Year Follow-Up
The patient underwent 1-year follow-up angiography and OCT, showing excellent revascularization results. Cross-sectional corresponding OCT images at 1-year follow-up and IVUS images post-index procedure were assessed. (A) Post-procedural angiography showing excellent results. (a) IVUS showing small BVS protrusion at LAD/LCX bifurcation. (b and c) IVUS showing a collapsed TL with well-expanded BVS implanted in the subintimal space. (d and e) IVUS showing an acceptable BVS expansion in the subintimal space even with the presence of calcification. (B) One-year follow-up angiography showing excellent results. (a0 ) OCT showing well-expanded BVS at the ostial LAD. (b0 and f0 ) OCT showing homogeneous NIH. (c0 and e0 ) OCT showing partial strut malapposition, possibly as a result of absorption of hematoma or thrombus. (d0 ) OCT showing elliptical BVS expansion as a result of calcification (SA 7.5 mm2, LA 5.7 mm2). (g0 ) OCT showing LAD/diagonal bifurcation. BVS ¼ bioresorbable vascular scaffold; LA ¼ lumen area; NIH ¼ neointimal hyperplasia; OCT ¼ optical coherence tomography; SA ¼ scaffold area; SD ¼ scaffold diameter; other abbreviations as in Figure 1.
REFERENCE 1. Gomez-Lara J, Brugaletta S, Farooq V, et al. Head-to-head comparison of the neointimal response between metallic and bioresorbable everolimus-eluting scaffolds using optical coherence tomography. J Am Coll Cardiol Intv 2011;4:1271–80.
KEY WORDS 1-year follow-up, bioresorbable vascular scaffold, chronic total occlusion, optical coherence tomography
e159
VOL. 7, NO. 10, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2014.04.022
IMAGES IN INTERVENTION
One-Year Follow-Up Optical Coherence Tomography After Implantation of Bioresorbable Vascular Scaffolds for a Chronic Coronary Total Occlusion Toru Naganuma, MD,*yz Azeem Latib, MD,*y Vasileios F. Panoulas, MD,*yx Katsumasa Sato, MD,*y Tadashi Miyazaki, MD,*y Sunao Nakamura, MD,z Antonio Colombo, MD*y
A
coronary
One-year follow-up angiography showed excellent
angiography because of worsening angina,
results in BVS-treated segments (Figure 2B). Optical
70-year-old
male
underwent
which demonstrated proximal left anterior
coherence tomography (OCT) demonstrated accept-
descending coronary artery (LAD) chronic total occlu-
able scaffold and lumen areas with homogeneous
sion (CTO) collateralized by septal branches from the
neointimal hyperplasia similar to the one reported
right coronary artery and an antegrade bridge
in the context of non-CTO lesions (1). Furthermore,
(Figure 1A). The lesion was penetrated using retro-
there was no evidence of intraluminal masses. The
grade subintimal tracking (Figure 1B). Intravascular
patient remained on dual antiplatelet therapy since
ultrasound (IVUS) after pre-dilation with a 2.5-mm
his index procedure. Of note, partial strut malap-
balloon demonstrated that the retrograde guidewire
position was noted on OCT that may be possibly due
entered into subintimal space because of calcification
to: 1) absorption of hematoma or thrombus; 2) late
(Figure 1C, a and b). The re-entry point to the true
scaffold recoil; and/or 3) low sensitivity of IVUS to
lumen was distal to the LAD ostium (Figure 1C, c). A
assess for strut malapposition as compared with OCT.
total of 2 bioresorbable vascular scaffolds (BVS)
This case suggests the feasibility of BVS use in a CTO
(Abbott
lesion as well as its efficacy up to 1-year follow-up.
Vascular,
Santa
Clara,
California)
were
implanted without scaffold overlap, followed by post-dilation with a 3.25-mm noncompliant balloon.
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
Post-procedural IVUS showed well-expanded BVS
Antonio Colombo, Cardiac Catheterization Labora-
within the subintimal space and a collapsed true
tory, EMO-GVM Centro Cuore Columbus, 48 Via M.
lumen (Figure 2A, a–e). At that time, there was no
Buonarroti,
evidence of strut malapposition.
emocolumbus.it.
20145
Milan,
Italy.
From the *Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; yInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; zInterventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan; and xImperial College London, National Heart and Lung Institute, London, United Kingdom. Dr. Latib is on the advisory board of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received April 7, 2014; accepted April 10, 2014.
E-mail:
info@
e158
Naganuma et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014
Follow-Up OCT After Treatment of CTO With BVS
OCTOBER 2014:e157–9
F I G U R E 1 Coronary Angiography and IVUS Showing Retrograde Subintimal Tracking
A 70-year-old male underwent coronary angiography demonstrating a proximal LAD CTO. The lesion was penetrated using retrograde subintimal tracking technique. IVUS after pre-dilation with a 2.5-mm balloon demonstrated that the retrograde guidewire entered into subintimal space. (A) Initial angiography showing proximal LAD CTO (arrows) collateralized by septal branches from the right coronary artery and an antegrade bridge. (B) Successful retrograde subintimal tracking. (C) IVUS after pre-dilation with a 2.5-mm balloon demonstrating that the retrograde guidewire entered into subintimal space due to calcification. (a) IVUS catheter placed in the subintimal space, surrounded by hematoma (arrowheads). (b) IVUS catheter placed in the subintimal space, outside of calcification (Calc.). (c) IVUS longitudinal view showing that the re-entry point was distal to LAD ostium. CTO ¼ chronic total occlusion; IVUS ¼ intravascular ultrasound; LAD ¼ left anterior descending coronary artery; LCX ¼ left circumflex coronary artery; TL ¼ true lumen.
Naganuma et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 10, 2014 OCTOBER 2014:e157–9
Follow-Up OCT After Treatment of CTO With BVS
F I G U R E 2 IVUS Images at the End of the Index Procedure and OCT Images at 1-Year Follow-Up
The patient underwent 1-year follow-up angiography and OCT, showing excellent revascularization results. Cross-sectional corresponding OCT images at 1-year follow-up and IVUS images post-index procedure were assessed. (A) Post-procedural angiography showing excellent results. (a) IVUS showing small BVS protrusion at LAD/LCX bifurcation. (b and c) IVUS showing a collapsed TL with well-expanded BVS implanted in the subintimal space. (d and e) IVUS showing an acceptable BVS expansion in the subintimal space even with the presence of calcification. (B) One-year follow-up angiography showing excellent results. (a0 ) OCT showing well-expanded BVS at the ostial LAD. (b0 and f0 ) OCT showing homogeneous NIH. (c0 and e0 ) OCT showing partial strut malapposition, possibly as a result of absorption of hematoma or thrombus. (d0 ) OCT showing elliptical BVS expansion as a result of calcification (SA 7.5 mm2, LA 5.7 mm2). (g0 ) OCT showing LAD/diagonal bifurcation. BVS ¼ bioresorbable vascular scaffold; LA ¼ lumen area; NIH ¼ neointimal hyperplasia; OCT ¼ optical coherence tomography; SA ¼ scaffold area; SD ¼ scaffold diameter; other abbreviations as in Figure 1.
REFERENCE 1. Gomez-Lara J, Brugaletta S, Farooq V, et al. Head-to-head comparison of the neointimal response between metallic and bioresorbable everolimus-eluting scaffolds using optical coherence tomography. J Am Coll Cardiol Intv 2011;4:1271–80.
KEY WORDS 1-year follow-up, bioresorbable vascular scaffold, chronic total occlusion, optical coherence tomography
e159
