“Bioresorbable Scaffold Failure; an interactive, step by step case”

A fifty-four-year-old hypertensive, diabetic man, who had two decades before suffered an inferior myocardial infarction, presented with recurrent angina and evidence of ischaemia with effort testing. A critically tight mid-left anterior descending artery stenosis (Syntax score 5) was thereafter successfully addressed with percutaneous intervention (Absorb 3mm X 28mm Bioresorbable scaffold). The lesion was carefully pre-dilated (Falcon 3mm X 14mm balloon) and post-dilated (NC Sprinter 3mm X 21mm balloon). The final result revealed TIMI-3 flow and no residual stenosis or evidence of dissection. The patient remained asymptomatic for a period of fourteen months but unfortunately then complained of further angina with lateral ischaemia on stress testing. The culprit lesion was significant restenosis of the proximal Absorb scaffold. Optical Coherence Tomography demonstrated a focal area of neointimal hyperplasia in the proximal scaffold, which had not been under-deployed. There was also no evidence of coronary thrombus. The lesion was pre-dilated with a Flextome Cutting balloon (3.5 x 15mm). The final result was excellent after deployment of a Supralimus-Core stent (3.5mm X 16mm) to high inflation pressure. A different drug was chosen as everolimus had failed to prevent restenosis. Our patient currently remains asymptomatic a year later.