Short communication
Chronic total occlusion successfully treated with a bioresorbable everolimus-eluting vascular scaffold

Fully bioresorbable vascular scaffolds (BVS) are a new approach to the percutaneous treatment of coronary artery disease. These scaffolds provide transient vessel support and drug delivery to the vessel wall without the potential long-term limitations of a traditional metallic drug-eluting stent (DES). The BVS have been shown to restore vascular function and enable positive vascular remodelling; they also do not preclude coronary artery bypass grafting [1–3]. However, BVS have not yet been fully tested in complex lesions, including chronic total occlusion (CTO).
We report a CTO case successfully treated with a second-generation bioabsorbable drug-eluting scaffold.
A 52-year-old woman with type 1 diabetes was admitted to our centre due to severe chronic stable angina. A myocardial perfusion test revealed significant ischaemia involving the anterior wall. The patient underwent coronary angiography which demonstrated total occlusion of the mid-portion of the left anterior descending (LAD) coronary artery (Figure 1 A). Percutaneous coronary intervention (PCI) was performed using a conventional antegrade approach and an everolimus 2.5 mm × 28 mm BVS 1.1 (Absorb BVS, Abbott Vascular, Santa Clara, CA, USA) was implanted in the LAD (Figure 1 B). The scaffold was post-dilated with a 2.5-mm non-compliant balloon, slowly inflated at 12 ATM.
The final angiogram showed satisfactory results with TIMI 3 flow in the LAD (Figure 1 C). Frequency domain optical coherence tomography (FD-OCT) pullback was performed on the implanted scaffold (C7 System, St Jude Medical, St Paul, USA). Longitudinal view and cross-sections demonstrated good strut apposition and scaffold expansion (Figure 2). At the 6-month follow-up the patient remained asymptomatic.

References

1. Ormiston JA, Serruys PW, Regar E. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): a prospective open-label trial. Lancet 2008; 371: 899-907.
2. Serruys PW, Garcia-Garcia HM, Onuma Y. From metallic cages to transient bioresorbable scaffolds: change in paradigm of coronary revascularization in the upcoming decade? Eur Heart J 2012; 33: 16-25.
3. Onuma Y, Serruys PW. Bioresorbable scaffold: the advent of a new era in percutaneous coronary and peripheral revascularization? Circulation 2011; 123: 779-97.