Complex Coronary Intervention with Overlapping of Bioresorbable Scaffolds. Case Report and New Insights Review in the use of Bioresorbable Vascular Scaffolds Guided by OCT

In recent years, the history of percutaneous coronary intervention has had a remarkable evolution. Currently, in México are available the Bioresorbable vascular scaffolds (BVS). We present the case and review of the published evidence, a new option for intervention with these devices, a complex case with three overlapping BVS (Absorb, Abbott Vascular, Santa Clara, California)guided by optical coherence tomography. We present the case of a male patient of 57 years old with a medical history of systemic arterial hypertension and presented at our service with a history of stable chronic coronary disease. A myocardial perfusion study was performed (severe myocardial ischemia in the anterolateral Wall). A diagnostic coronary angiography study was performed, which revealed chronic total occlusion of the anterior descending artery (LAD). The lesion was prepared, pre dilating with two compliant balloons of 1.50x20mm and 2.50x20mm. The diagonal branch was pre-dilated with a compliant balloon of 2.0x15mm. In the diagonal branch, a chromium-cobalt stent and Everolimus-eluting stent of 2.50x16mm at 12 atmospheres were implanted. The long lesion of the LAD was treated with three BVS from distal to proximal of 2.50x18mm, 3.0x28mm and 3.50x18mm at 8 atmospheres, overlapped by the platinum guides of the devices. Optimization was performed with a non compliant balloon 3.0x20mm to 14 atmospheres, distal to proximal. Finally, an OCT was performed to assess the correct positioning of the three BVS, as well as the area of ​​overlap that was 2mm. Until the moment of the presentation of this case, the patient has 18 months without complications or symptoms.