Abstract
We report the long-term outcome of a case of “full plastic jacket” treatment consisting of three bioresorbable scaffolds to manage a subtotally occluded left anterior descending artery with associated severe bare metal in-stent restenosis. Angiography 36 months’ post procedure revealed an excellent result with negative fractional flow reserve result. Bioresorbable scaffolds may be an attractive option for in-stent restenosis due to the avoidance of an additional metallic layer, and this case is unusual regarding the total scaffold length used and long term angiographic follow-up.
Highlights
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We report the long term outcome of a case of “full plastic jacket” treatment consisting of three bioresorbable scaffolds to manage a subtotally occluded left anterior descending artery with associated severe bare metal in-stent restenosis.
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Angiography 36 months’ post procedure revealed an excellent result with negative fractional flow reserve result.
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Bioresorbable scaffolds may be an attractive option for in-stent restenosis.
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Case report
A 63-year-old male with prior history of multiple previous percutaneous coronary interventions (PCI) underwent angiography at our institution. Approximately 15 years ago, he underwent PCI, and 2 overlapping bare metal stents (BMS) were implanted from proximal to mid left anterior descending artery (LAD) with a further BMS in the distal LAD. An angiogram performed several years later for stable angina revealed a subtotally occluded LAD involving significant BMS in-stent restenosis (ISR; Fig. 1 A ). The lesion was pre-dilated with non-compliant (NC) balloons from proximal to distal LAD (3.5, 3, 2.5 mm up to 22 atm [atm]). Three BRS (ABSORB; Abbott Vascular, Santa Clara, CA, USA) were implanted (3.0×28 mm; 3.0×28 mm; 2.5×28 mm) with a minimally overlapping technique. Post-dilatation was performed with NC balloons to high pressures (3.0×15 mm to 18 atm; 2.5×12 mm to 20 atm). There was an excellent angiographic final result with negative fractional flow reserve (FFR) of 0.84. ( Fig. 1 B).
