Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 63, No. 25, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.05.107

IMAGES IN CARDIOLOGY

Treatment of Coronary In-Stent Restenosis With Bioabsorbable Vascular Scaffolds Fernando Alfonso, MD, Julio Nuccio, MD, Cecilia Cuevas, MD, Alberto Cárdenas, MD, Nieves Gonzalo, MD, Pilar Jimenez-Quevedo, MD Madrid, Spain

From the Department of Interventional Cardiology, Cardiovascular Institute, San Carlos University Hospital, IdISSC, Madrid, Spain. Dr. Gonzalo has received speakers’ honoraria from St. Jude Medical and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received May 4, 2013; accepted May 7, 2013.

77-year-old woman was admitted for angina 13 years after receiving a bare-metal stent in the left anterior descending coronary artery. Angiography showed in-stent restenosis (ISR). Optical coherence tomography (OCT) revealed a well-expanded stent with focal ISR (arrow in longitudinal display, A) and heterogeneous tissue, including lipid pools (D) and and calcified segments (#), suggesting neoatherosclerosis (B to D) (wire-artifact [*]). Most underlying struts were not visible. A bioabsorbable vascular scaffold (BVS) was deployed and subsequently post-dilated at high pressures to remove a residual waist. Final OCT revealed a minimal lumen area of 8 mm2. The classic “black box” BVS appearance (without shadowing) was identified, well apposed on residual intrastent tissue, overlying the bright artifacts (sharp shadows) of the underlying metallic struts (E to G). The therapy of choice for neoatherosclerosis remains unknown. BVS may emerge as an attractive therapeutic strategy for selected patients with ISR. In this setting, BVS avoids the need for an additional metal layer on the vessel wall. OCT provides unique insights on this novel therapeutic strategy.

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Treatment of coronary in-stent restenosis with bioabsorbable vascular scaffolds.

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