A Combination of Drug-Eluting Stents and Bioresorbable Vascular Scaffolds in the Treatment of Multivessel Coronary Artery Disease

Abstract

Optimal management of multivessel coronary artery disease can be complex. We report a 67-year-old male patient who was admitted to the Padua University Hospital, Padua, Italy, in 2014 with a non-ST-elevation myocardial infarction. Coronary angiography showed diffuse multiple sub-occlusive lesions of the proximal and distal left coronary vessels involving a long segment of the vessel. On intravascular ultrasonography (IVUS), the left main artery was moderately diseased with critically stenotic and calcified branch ostia. A successful percutaneous coronary intervention using the T-stenting and small protrusion technique with two drug-eluting stents (DES) was performed on the left main artery and its main branches. Two bioresorbable vascular scaffolds were also deployed in overlap at the mid to distal segments of the left anterior descending artery and overlapping a previous DES at the proximal segment. The full expansion and apposition of the struts and scaffolds to the vessel wall without residual stenosis was confirmed by IVUS.

Keywords: Case Report; Coronary Stenosis; Drug-Eluting Stents; Italy; Myocardial Infarction; Percutaneous Coronary Intervention; Ultrasonography.

Figure 1A–C:

Coronary angiography of a 67-year-old male patient from the (A) cranial right anterior oblique (RAO), (B) caudal RAO and (C) caudal left anterior oblique views showing multiple diffuse critical lesions of the proximal and distal segments of the left coronary arteries involving the left main trunk with a hazy proximal left circumflex artery (LCx) lesion. Despite evaluation from several planes, the stenosis of the proximal LCx artery remained unclear.

Figure 2A–C:

Intravascular ultrasonography (IVUS) of a 67-year-old male patient showing (A) moderate left main trunk disease, (B) multiple significant stenoses of the left anterior descending artery and (C) stenosis of the proximal left circumflex artery with eccentric superficial and deep dense calcific plaque (arrow). MLA = minimal lumen area.

Figure 3A–C:

Post-interventional cross-sectional intravascular ultrasonography of a 67-year-old male patient following the implantation of two bioresorbable vascular scaffolds and two drug-eluting stents. The stents were well-apposed and expanded with no signs of dissection at the (A) left main trunk, (B) proximal portion of the left anterior descending artery and (C) proximal portion of the left circumflex artery.

Figure 4A–C:

A: Post-interventional coronary angiography of a 67-year-old male patient following the implantation of two bioresorbable vascular scaffolds at the mid-distal portion of the left anterior descending artery and in overlap with a drug-eluting stent at the proximal portion. B and C: Cross-sectional intravascular ultrasonography images corresponding to sections of the coronary angiogram (yellow lines) showing the uniform and full expansion of the struts and scaffolds apposed to the intimo-medial membrane. All three concentric stents and scaffold layers were noted at overlap sites as discrete echo-bright structures. DES = drug-eluting stent; BVS = bioresorbable vascular scaffold.