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Impact of coronary calcification on outcomes after ABSORB scaffold implantation: insights from the GABI-R registry. Coron Artery Dis 2020; 31:578-585. [DOI: 10.1097/mca.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitomo S, Tanaka A, Candilio L, Azzalini L, Carlino M, Latib A, Colombo A. Different behaviors of bioresorbable vascular scaffold in different types of calcified lesion: Insights from intravascular imaging. J Cardiol Cases 2018; 17:126-129. [PMID: 30279873 DOI: 10.1016/j.jccase.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/08/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022] Open
Abstract
A 55-year-old male underwent percutaneous coronary intervention (PCI) for left anterior descending artery chronic total occlusion. After lesion preparation with non-compliant (NC) balloon, two bioresorbable vascular scaffolds (2.5/28 mm, 3.0/28 mm, Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) were implanted followed by 1:1 sized NC balloon post-dilatation at 20 atm. Final intravascular ultrasound (IVUS) showed acceptable BVS expansion in diffusely calcified lesions. Twenty-one months' follow-up coronary angiography revealed severe restenosis with reocclusion at the distal edge of the distal BVS. After recanalization with a 1.0 mm balloon, optical coherence tomography (OCT) was performed. Quantitative analysis comparing OCT and IVUS at the index procedure demonstrated that minimum scaffold area at follow-up became significantly smaller and with higher eccentricity, suggesting severe recoil at the lesions with thick calcium spot, whereas these changes were not observed at the lesion with relatively thin calcification. The lesions were successfully revascularized with drug-eluting stents and final OCT showed symmetric expansion of metallic stents. Our case demonstrates that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide PCI strategy with BVS. <Learning objective: Calcified lesions represent a challenging lesion subset for bioresorbable vascular scaffold (BVS) because of less radial strength of the latter. Quantitative analysis with intravascular imaging demonstrated that different types of calcification can have an impact on BVS expansion and recoil. In calcified lesions, an optimal implantation technique is mandatory to achieve the best possible results, and characterization of calcified lesions with intravascular imaging may be helpful to decide percutaneous coronary intervention strategy with BVS.>.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,The Hammersmith Hospital, Imperial College London, London, UK
| | - Lorenzo Azzalini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Mitomo S, Jabbour RJ, Latib A, Colombo A. Bioresorbable vascular scaffold implantation for severely calcified lesions after excimer laser lesion preparation. Catheter Cardiovasc Interv 2018; 92:1283-1288. [PMID: 30269391 DOI: 10.1002/ccd.27704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/03/2018] [Accepted: 05/30/2018] [Indexed: 11/11/2022]
Abstract
Bioresorbable vascular scaffolds (Absorb BVS, Abbott Vascular, Santa Clara, CA) temporarily elute antiproliferative drugs and provide vessel support, which then subsequently resorb to allow restoration of normal vessel function and architecture. To attain the best possible results with BVS, a dedicated implantation technique (PSP: adequate lesion preparation, proper sizing, postdilatation) is considered mandatory, and calcified lesions are one of the most challenging lesion subsets for BVS implantation. In five cases with severe calcifications refractory to balloon predilatation, we performed excimer laser catheter ablation (ELCA: Turbo Elite catheter; Spectranetics Corporation, Colorado Springs, CO, USA), which facilitated adequate lesion expansion with high-pressure noncompliant balloon inflation and BVS implantation. During the follow-up period (481 days [interquartile range: 445-579]), all patients continued dual antiplatelet therapy (DAPT) and there were no cases of cardiac death, myocardial infarction, or scaffold thrombosis. For treatment of severely calcified lesions with bioresorbable scaffolds, ELCA could be considered an effective potential strategy. After the procedure, prolonged DAPT was prescribed.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Yamaji K, Räber L, Windecker S. What determines long-term outcomes using fully bioresorbable scaffolds - the device, the operator or the lesion? EUROINTERVENTION 2017; 12:1684-1687. [DOI: 10.4244/eijv12i14a277] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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