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Cutting balloon use may ease the optimal apposition of bioresorbable vascular scaffold in in-stent stenosis.

Karabulut A, Demirci Y - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: Bioresorbable vascular scaffolds (BVS) have different mechanical properties as compared to metallic stents.Therefore, the standard procedural technique to achieve appropriate deployment may differ.Utilisation of debulking techniques, including cutting balloon and directional atherectomy prior to BVS deployment, is still questionable.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Faculty of Medicine, Acıbadem University, Acıbadem Atakent Hospital, Istanbul, Turkey.

ABSTRACT
Bioresorbable vascular scaffolds (BVS) have different mechanical properties as compared to metallic stents. Therefore, the standard procedural technique to achieve appropriate deployment may differ. Utilisation of debulking techniques, including cutting balloon and directional atherectomy prior to BVS deployment, is still questionable. Herein, we discuss a case of coronary in-stent restenosis and reveal the advantage of predilatation of the lesion with cutting balloon prior to BVS deployment.

No MeSH data available.


Related in: MedlinePlus

Right anterior oblique caudal view of left coronary arteries. This image shows proximal in-stent stenosis of the left anterior descending artery. Arrows indicate the edge of previous stents
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Figure 0001: Right anterior oblique caudal view of left coronary arteries. This image shows proximal in-stent stenosis of the left anterior descending artery. Arrows indicate the edge of previous stents

Mentions: A 29-year-old male patient presented with typical angina on exertion. In his medical background, coronary stenting (4.0 × 12 mm bare metal stent (BMS)) had been performed to the proximal left anterior descending artery (LAD) 2 years previously. Due to stent restenosis, another BMS (4.0 × 12 mm) was deployed to an in-stent lesion a year later. The patient was followed with aspirin, clopidogrel, statin, and angiotensin-converting enzyme (ACE) inhibitor. In the final presentation, left ventricular ejection fraction was normal and exercise stress test suggested coronary ischaemia. Coronary angiography showed diffuse in-stent 70–75% stenosis in the LAD (Figure 1). Subsequently, coronary intervention with BVS was scheduled. Cutting balloon was preferred for predilation of the lesion due to extensive diffuse disease and the presence of two overlapping BMSs that could resist the expansion of the new stent/scaffold. After crossing of the lesion, predilatation was performed with 3.5 × 15 cutting balloon at the maximal proposed pressure (Figure 2; note dense and diffuse plaque burden resisting the predilatation), and a 3.5 × 18 BVS (Absorb, Abbot Vascular) was deployed, also with maximal proposed pressure. After post dilation of BVS with a non-compliant balloon, the procedure was terminated with a successful result (Figure 3).


Cutting balloon use may ease the optimal apposition of bioresorbable vascular scaffold in in-stent stenosis.

Karabulut A, Demirci Y - Postepy Kardiol Interwencyjnej (2015)

Right anterior oblique caudal view of left coronary arteries. This image shows proximal in-stent stenosis of the left anterior descending artery. Arrows indicate the edge of previous stents
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372637&req=5

Figure 0001: Right anterior oblique caudal view of left coronary arteries. This image shows proximal in-stent stenosis of the left anterior descending artery. Arrows indicate the edge of previous stents
Mentions: A 29-year-old male patient presented with typical angina on exertion. In his medical background, coronary stenting (4.0 × 12 mm bare metal stent (BMS)) had been performed to the proximal left anterior descending artery (LAD) 2 years previously. Due to stent restenosis, another BMS (4.0 × 12 mm) was deployed to an in-stent lesion a year later. The patient was followed with aspirin, clopidogrel, statin, and angiotensin-converting enzyme (ACE) inhibitor. In the final presentation, left ventricular ejection fraction was normal and exercise stress test suggested coronary ischaemia. Coronary angiography showed diffuse in-stent 70–75% stenosis in the LAD (Figure 1). Subsequently, coronary intervention with BVS was scheduled. Cutting balloon was preferred for predilation of the lesion due to extensive diffuse disease and the presence of two overlapping BMSs that could resist the expansion of the new stent/scaffold. After crossing of the lesion, predilatation was performed with 3.5 × 15 cutting balloon at the maximal proposed pressure (Figure 2; note dense and diffuse plaque burden resisting the predilatation), and a 3.5 × 18 BVS (Absorb, Abbot Vascular) was deployed, also with maximal proposed pressure. After post dilation of BVS with a non-compliant balloon, the procedure was terminated with a successful result (Figure 3).

Bottom Line: Bioresorbable vascular scaffolds (BVS) have different mechanical properties as compared to metallic stents.Therefore, the standard procedural technique to achieve appropriate deployment may differ.Utilisation of debulking techniques, including cutting balloon and directional atherectomy prior to BVS deployment, is still questionable.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Faculty of Medicine, Acıbadem University, Acıbadem Atakent Hospital, Istanbul, Turkey.

ABSTRACT
Bioresorbable vascular scaffolds (BVS) have different mechanical properties as compared to metallic stents. Therefore, the standard procedural technique to achieve appropriate deployment may differ. Utilisation of debulking techniques, including cutting balloon and directional atherectomy prior to BVS deployment, is still questionable. Herein, we discuss a case of coronary in-stent restenosis and reveal the advantage of predilatation of the lesion with cutting balloon prior to BVS deployment.

No MeSH data available.


Related in: MedlinePlus