Yonsei Med J.  2017 Sep;58(5):1071-1074. 10.3349/ymj.2017.58.5.1071.

Optical Coherence Tomography and Stent Boost Imaging Guided Bioresorbable Vascular Scaffold Overlapping for Coronary Chronic Total Occlusion Lesion

• Li H
• Rha SW
• Choi CU
• Oh DJ

• KMID: 2418949
• DOI: http://doi.org/10.3349/ymj.2017.58.5.1071

Abstract

We report herein the optical coherence tomography (OCT) and stent boost imaging guided bioresorbable vascular scaffold (BVS) implantation for right coronary artery (RCA) chronic total occlusion (CTO) lesion. The gold standard for evaluating BVS expansion after percutaneous coronary intervention is OCT. However, stent boost imaging is a new technique that improves fluoroscopy-based assessments of stent overlapping, and the present case shows clinical usefulness of OCT and stent boost imaging guided "˜overlapping' BVS implantation via antegrade approach for a typical RCA CTO lesion.

Keyword

CTO; BVS; OCT; stent boost

MeSH Terms

*Absorbable Implants
*Blood Vessel Prosthesis
Chronic Disease
Coronary Angiography
Coronary Artery Disease/*surgery
Humans
Male
Middle Aged
Myocardial Revascularization
*Stents
Tomography, Optical Coherence/*methods
Treatment Outcome

Figure

• 

  Fig. 1 Baseline coronary angiography. (A) Chronic total occlusion of mid right coronary artery (RCA) (arrow). (B) Collateral flow from left coronary artery to RCA (grade 2, arrow).

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  Fig. 2 Revascularization for CTO in RCA. (A) Runthrough guide wire was advanced through Corsair microcatheter. (B) Fielder XT-A wire successfully crossed the CTO segment. (C) Fielder XT-A was exchanged to Runthrough soft wire, and after balloon dilation (1.3×10 mm Laxa and 2.0×15 mm Laxa balloon), we performed an OCT study of RCA. (D) OCT findings after predilation. (E and F) Two overlapping 3.0×18 mm and 3.0×28 mm BVSs (Absorb BVS) were implanted from mid to distal RCA. CTO, chronic total occlusion; RCA, right coronary artery; OCT, optical coherence tomography; BVS, bioresorbable vascular scaffold.

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  Fig. 3 After BVS implantation. (A) Stent boost subtract image, showing definite edge detection for safe overlapping of two BVSs (arrow: overlapping site). (B) Adjuvant post-dilation was done based on the OCT finding and stentboost image with 3.0×8.0 mm Pantera LEO non-compliant balloon, slowly inflated at high pressure (18 atm) for the optimal BVS expansion. (C) OCT finding after two BVS overlapping stenting, showing optimal BVS expansion without malapposition (arrow: overlapping site). (D) Post BVS implantation stent boost subtract image clearly showed location of BVS edges, both proximal edge (upper arrow), BVS tracing of the longitudinal stent edge (side arrows) and distal end of overlapping site (lower arrow). (E and F) Final angiography at index PCI (arrows: BVS site) (E) and follow up angiography at 6 months (arrows: BVS site) (F). OCT, optical coherence tomography; BVS, bioresorbable vascular scaffold; PCI, percutaneous coronary intervention.

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