Case report
Sealing a ruptured non-culprit coronary plaque in a patient with acute myocardial infarction with bioresorbable vascular scaffolds
Selar com suportes vasculares bioabsorvíveis a rotura de uma placa coronária não culpada num doente com enfarte agudo do miocárdio
Javier Cuesta, Fernando Rivero, Teresa Bastante, Amparo Benedicto, Guillermo Diego, Fernando Alfonso
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Hospital Universitario de La Princesa, Madrid, Spain
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infarction with bioresorbable vascular scaffolds" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213.e1" "paginaFinal" => "213.e3" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Cuesta, Fernando Rivero, Teresa Bastante, Amparo Benedicto, Guillermo Diego, Fernando Alfonso" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Cuesta" ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Rivero" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Bastante" ] 3 => array:2 [ "nombre" => "Amparo" "apellidos" => "Benedicto" ] 4 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Diego" ] 5 => array:4 [ "nombre" => "Fernando" "apellidos" => "Alfonso" "email" => array:1 [ 0 => "javicuestacuesta@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario de La Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Selar com suportes vasculares bioabsorvíveis a rotura de uma placa coronária não culpada num doente com enfarte agudo do miocárdio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1602 "Ancho" => 2464 "Tamanyo" => 459364 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography. (A) A ruptured cap and a large posterior cavity (+) are visualized; (B and C) images showing a lipid plaque (L) and a large red thrombus (T) protruding into the coronary lumen (arrows); (D) longitudinal reconstruction highlighting the ruptured plaque cavity (+) in the flow direction. GC: guiding catheter; *: wire artefact.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 49-year-old man, a smoker and with hypertension and dyslipidemia, was admitted to the emergency department for rescue primary angioplasty. Marked anterior ST-segment elevation (5 mm in leads V2-V4) was seen on the ECG. Coronary angiography showed a critical coronary lesion in the mid segment of the left anterior descending coronary artery in which a 2.75 mm×13 mm bare-metal stent was successfully implanted. The right coronary artery showed a complex but moderate lesion in its proximal segment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Two days later, a new coronary angiogram was performed to further assess the proximal right coronary lesion. Optical coherence tomography (OCT) disclosed a large thin-cap fibroatheroma with a clear fibrous-cap rupture and a large cavity along the direction of coronary flow (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Several coronary thrombi were also detected. Although the lumen area was relatively preserved, these unique OCT findings of active plaque complication were instrumental in the decision to treat this lesion. A bioresorbable vascular scaffold (BVS) was successfully implanted (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Multivessel coronary artery disease is present in nearly half of patients with acute myocardial infarction undergoing primary angioplasty.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The optimal timing for the treatment of non-culprit lesions in these patients remains controversial, although a staged procedure is frequently selected following current recommendations.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Only severe coronary lesions are treated during these repeat procedures. However, intracoronary imaging techniques have demonstrated that many patients with acute myocardial infarction also have complicated plaques in non-culprit lesions. Notably, some of these complicated plaques are not identified by angiography. OCT provides novel insights in this regard as its unique resolution enables the presence of plaque rupture with associated intracoronary thrombus to be readily identified.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> In our patient, angiography showed a complex but moderate lesion in the proximal right coronary artery, but OCT disclosed the presence of a large complicated thin-cap fibroatheroma with a large rupture associated with intracoronary thrombi. We used a BVS to treat this complicated plaque, in spite of a relatively large residual minimal lumen area, with excellent results. BVS are especially attractive to seal and passivate vulnerable coronary plaques, as these devices may lead to complete vessel wall restoration at late follow-up.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Although there is little evidence to support this strategy, further studies are warranted to answer this important clinical question. Whether the additional information provided by OCT can help guide interventions in non-culprit lesions in patients presenting with an acute myocardial infarction deserves a prospective evaluation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres458067" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec481069" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres458068" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec481068" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-20" "fechaAceptado" => "2014-08-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec481069" "palabras" => array:3 [ 0 => "Optical coherence tomography" 1 => "Non-culprit lesion" 2 => "Bioresorbable vascular scaffolds" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec481068" "palabras" => array:3 [ 0 => "Tomografia de coerência ótica" 1 => "Lesão não culpada" 2 => "Suportes vasculares bioabsorbíveis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 49-year-old man was admitted to the emergency department suffering from a large anterior myocardial infarction that was treated by rescue PCI. The patient also had a moderate but complex lesion in the proximal segment of the right coronary artery. Optical coherence tomography showed striking images of a ruptured and ulcerated plaque with significant thrombus content. Although the lumen was not compromised, these unique findings prompted us to treat this non-culprit lesion. We selected a bioresorbable vascular scaffold with the aim of sealing and passivating this complicated and high-risk plaque.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Homem de 49 anos, admitido no serviço de urgência, que padecia de enfarte do miocárdio anterior extenso e que tinha sido tratado com intervenção coronária percutânea (ICP) de recurso. O doente também apresentou lesão moderada mas complexa no segmento mais próximo da coronária direita. A tomografia de coerência óptica revelou imagens impressionantes de uma placa com rotura e ulcerada com trombos significativos. Embora o lúmen não tenha sido comprometido, estas constatações únicas levaram-nos a tratar rapidamente esta lesão não culpada. Selecionámos um suporte vascular bioabsorbível com o objetivo de selar e de solucionar o caso desta placa complicada e de alto risco.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1602 "Ancho" => 2464 "Tamanyo" => 459364 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography. (A) A ruptured cap and a large posterior cavity (+) are visualized; (B and C) images showing a lipid plaque (L) and a large red thrombus (T) protruding into the coronary lumen (arrows); (D) longitudinal reconstruction highlighting the ruptured plaque cavity (+) in the flow direction. GC: guiding catheter; *: wire artefact.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1591 "Ancho" => 2500 "Tamanyo" => 478268 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography images after intervention. (A) A large residual thin-cap fibroatheroma is partially visualized behind the scaffold; (B and C) a residual thrombus (arrows) protruding slightly into the lumen and a lipid plaque (L) are also visualized; (D) longitudinal image showing a fully expanded scaffold. GC: guiding catheter; *: wire artefact.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multivessel intervention during primary angioplasty: too greedy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Alfonso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2009.12.001" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "32" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20129565" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.J. Vlaar" 1 => "K.D. Mahmoud" 2 => "D.R. Holmes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2011.03.046" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2011" "volumen" => "58" "paginaInicial" => "692" "paginaFinal" => "703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21816304" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Difference of culprit lesion morphologies between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Ino" 1 => "T. Kubo" 2 => "A. Tanaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2010.09.022" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "76" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21251632" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First serial assessment at 6 months and 2 years of the second generation of absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Ormiston" 1 => "P.W. Serruys" 2 => "Y. Onuma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.112.971549" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "620" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23048057" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003400000003/v4_201503200652/S0870255115000402/v4_201503200652/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000003/v4_201503200652/S0870255115000402/v4_201503200652/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000402?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
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| 2024 Outubro | 38 | 34 | 72 |
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| 2024 Junho | 43 | 28 | 71 |
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| 2024 Maro | 27 | 25 | 52 |
| 2024 Fevereiro | 34 | 25 | 59 |
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| 2023 Novembro | 40 | 19 | 59 |
| 2023 Outubro | 27 | 16 | 43 |
| 2023 Setembro | 25 | 16 | 41 |
| 2023 Agosto | 37 | 18 | 55 |
| 2023 Julho | 39 | 5 | 44 |
| 2023 Junho | 18 | 13 | 31 |
| 2023 Maio | 39 | 19 | 58 |
| 2023 Abril | 15 | 6 | 21 |
| 2023 Maro | 19 | 14 | 33 |
| 2023 Fevereiro | 28 | 25 | 53 |
| 2023 Janeiro | 21 | 7 | 28 |
| 2022 Dezembro | 34 | 20 | 54 |
| 2022 Novembro | 35 | 17 | 52 |
| 2022 Outubro | 24 | 15 | 39 |
| 2022 Setembro | 20 | 29 | 49 |
| 2022 Agosto | 22 | 26 | 48 |
| 2022 Julho | 21 | 38 | 59 |
| 2022 Junho | 27 | 23 | 50 |
| 2022 Maio | 19 | 28 | 47 |
| 2022 Abril | 42 | 25 | 67 |
| 2022 Maro | 20 | 29 | 49 |
| 2022 Fevereiro | 25 | 21 | 46 |
| 2022 Janeiro | 28 | 23 | 51 |
| 2021 Dezembro | 23 | 27 | 50 |
| 2021 Novembro | 37 | 34 | 71 |
| 2021 Outubro | 36 | 37 | 73 |
| 2021 Setembro | 26 | 33 | 59 |
| 2021 Agosto | 23 | 26 | 49 |
| 2021 Julho | 17 | 14 | 31 |
| 2021 Junho | 24 | 20 | 44 |
| 2021 Maio | 24 | 24 | 48 |
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| 2020 Setembro | 53 | 8 | 61 |
| 2020 Agosto | 16 | 8 | 24 |
| 2020 Julho | 60 | 6 | 66 |
| 2020 Junho | 55 | 4 | 59 |
| 2020 Maio | 38 | 2 | 40 |
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| 2018 Agosto | 32 | 10 | 42 |
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| 2018 Junho | 58 | 7 | 65 |
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| 2018 Abril | 67 | 7 | 74 |
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| 2018 Fevereiro | 53 | 7 | 60 |
| 2018 Janeiro | 60 | 2 | 62 |
| 2017 Dezembro | 112 | 8 | 120 |
| 2017 Novembro | 59 | 9 | 68 |
| 2017 Outubro | 27 | 10 | 37 |
| 2017 Setembro | 42 | 8 | 50 |
| 2017 Agosto | 49 | 13 | 62 |
| 2017 Julho | 31 | 5 | 36 |
| 2017 Junho | 59 | 11 | 70 |
| 2017 Maio | 44 | 14 | 58 |
| 2017 Abril | 13 | 8 | 21 |
| 2017 Maro | 31 | 23 | 54 |
| 2017 Fevereiro | 28 | 22 | 50 |
| 2017 Janeiro | 24 | 13 | 37 |
| 2016 Dezembro | 40 | 5 | 45 |
| 2016 Novembro | 29 | 4 | 33 |
| 2016 Outubro | 36 | 6 | 42 |
| 2016 Setembro | 88 | 4 | 92 |
| 2016 Agosto | 20 | 7 | 27 |
| 2016 Julho | 9 | 4 | 13 |
| 2016 Junho | 22 | 7 | 29 |
| 2016 Maio | 17 | 6 | 23 |
| 2016 Abril | 32 | 4 | 36 |
| 2016 Maro | 47 | 13 | 60 |
| 2016 Fevereiro | 62 | 27 | 89 |
| 2016 Janeiro | 52 | 23 | 75 |
| 2015 Dezembro | 59 | 13 | 72 |
| 2015 Novembro | 58 | 13 | 71 |
| 2015 Outubro | 44 | 23 | 67 |
| 2015 Setembro | 50 | 17 | 67 |
| 2015 Agosto | 50 | 15 | 65 |
| 2015 Julho | 36 | 4 | 40 |
| 2015 Junho | 36 | 8 | 44 |
| 2015 Maio | 66 | 22 | 88 |
| 2015 Abril | 80 | 46 | 126 |
| 2015 Maro | 86 | 65 | 151 |
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