Bioresorbable vascular scaffold for coronary in-stent restenosis: a novel concept

Abstract

The management of patients with significant in-stent restenosis (ISR) with drug-eluting stent is still not well defined. Various treatment modalities include plain old balloon angioplasty (POBA), metallic stent, cutting or scoring balloon and drug-eluting balloon (DEB). Bioresorbable vascular scaffold (BVS) is the latest technology for the treatment of de novo coronary artery lesions. The use of BVS in ISR is based on the rationale of local drug delivery as achieved by DEB without the permanent bi-layer of metal and also stabilizes dissection flaps and prevents acute recoil as provided by metallic stent. To the best of our knowledge this is the first case report of the use of BVS in patient with ISR.

Keywords: Bioresorbable vascular scaffold; Drug-eluting balloon; Drug-eluting stent; In-stent restenosis.

Fig. 1

Left coronary angiogram in RAO caudal (Panel A) and AP cranial view showing significant ISR in proximal LAD (Arrow, Panel B). AP caudal view showing rotablation with 1.5 mm burr (Arrow, Panel C) and predilation with PTCA balloon dilatation catheter (Arrow, Panel D) (RAO, Right anterior oblique; AP, Anterio–posterior; ISR, In-stent restenosis; LAD, left anterior descending artery; PTCA, Percutaneous transluminal coronary angioplasty).

Fig. 2

BVS platinum markers representing the edges of the scaffold are seen placed across the lesion in RAO caudal (Arrow, Panel A) and AP cranial view (Arrow, Panel B) confirming the proper position of the scaffold (BVS, Bioresorbable scaffold; RAO, Right anterior oblique; AP, Anterio–posterior).