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Image in Cardiology
Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings
Restenose de stent vascular biorreabsorvível tratada com balão coberto de sirolimus: achados da tomografia de coerência ótica
Javier Cuesta
Autor para correspondência
javicuestacuesta@hotmail.com

Corresponding author.
, Marcos García-Guimaraes, Teresa Bastante, Fernando Rivero, Ramón Maruri, Fernando Alfonso
Hospital Universitario de La Princesa, Madrid, Spain
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        "titulo" => "Restenose de <span class="elsevierStyleItalic">stent</span> vascular biorreabsorv&#237;vel tratada com bal&#227;o coberto de sirolimus&#58; achados da tomografia de coer&#234;ncia &#243;tica"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography&#46; &#40;A&#41; A BVS was implanted in the proximal segment of the left anterior descending coronary artery two years ago &#40;white arrows&#41;&#46; &#40;B&#41; Severe restenosis was observed &#40;yellow arrow&#41;&#46; &#40;C&#41; Excellent outcome after sirolimus-eluting balloon &#40;yellow arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old man was admitted for unstable angina&#46; Two-years ago he was treated with two bioresorbable vascular scaffolds &#40;BVSs&#41; on the proximal and distal segments of the left anterior descending coronary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#44; white arrows&#41;&#46; Coronary angiography showed critical in-scaffold restenosis of the proximal BVS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#44; yellow arrow&#41;&#46; Optical coherence tomography revealed heterogeneous tissue filling the BVS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; A&#44; B and D&#41; with areas depicting bright neointimal hyperplasia with dorsal attenuation and marked shadowing of the underlying BVS struts&#46; There was no evidence of scaffold disruption and neoatherosclerosis was considered the cause of late BVS failure&#46; The patient was treated with a 3&#215;15-mm sirolimus coated balloon catheter &#40;drug-eluting balloon&#44; DEB&#41; &#40;ratio of drug-eluting balloon to BVS size&#58; 1&#58;1&#41; &#40;MagicTouch&#8482;&#44; Concept Medical Inc&#46;&#41; with excellent angiographic &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41; and optical coherence tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; C and E&#41; outcomes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The unique properties of BVS&#44; which provide the benefits of a powerful antiproliferative drug without the need for a permanent metal layer&#44; make this device an attractive strategy during coronary interventions&#46; Late BVS failure is a rare event and the treatment of choice for BVS restenosis has yet to be established&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sirolimus-eluting balloons provide a novel&#44; highly attractive therapy for patients with in-stent restenosis&#44; but there are very limited data about the use of DEB in this context&#46; Furthermore&#44; the relative efficacy of this novel therapeutic modality&#44; as compared with second-generation drug-eluting stents &#40;DESs&#41;&#44; has not yet been established&#46; The use of DEB for BVS restenosis would avoid the need for an additional permanent metal layer &#40;&#8220;leave nothing behind&#8221; strategy&#41;&#46; This could be of particular value when excellent final outcomes are obtained&#44; as in our case&#46; To the best of our knowledge&#44; this is the first report describing the use of sirolimus-eluting balloons for late BVS failure as a result of neoatherosclerosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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