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Restenosis in a Collapsed Magnesium Bioresorbable Scaffold

2017; Lippincott Williams & Wilkins; Volume: 10; Issue: 10 Linguagem: Inglês

10.1161/circinterventions.117.005677

1941-7632

Trine Ørhøj Barkholt, Omeed Neghabat, Christian Juhl Terkelsen, Evald Høj Christiansen, Niels Ramsing Holm,

Cardiac Valve Diseases and Treatments

HomeCirculation: Cardiovascular InterventionsVol. 10, No. 10Restenosis in a Collapsed Magnesium Bioresorbable Scaffold Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBRestenosis in a Collapsed Magnesium Bioresorbable Scaffold Trine Ørhøj Barkholt, MD, Omeed Neghabat, MS, Christian Juhl Terkelsen, MD, PhD, Evald Høj Christiansen, MD, PhD; and Niels Ramsing Holm, MD Trine Ørhøj BarkholtTrine Ørhøj Barkholt From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. , Omeed NeghabatOmeed Neghabat From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. , Christian Juhl TerkelsenChristian Juhl Terkelsen From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. , Evald Høj ChristiansenEvald Høj Christiansen From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. and Niels Ramsing HolmNiels Ramsing Holm From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. Originally published17 Oct 2017https://doi.org/10.1161/CIRCINTERVENTIONS.117.005677Circulation: Cardiovascular Interventions. 2017;10:e005677IntroductionOptical coherence tomography (OCT) may provide important mechanistic information in restenosis after treatment using bioresorbable scaffolds (BRS). Here, we present the signature findings by OCT of a novel magnesium BRS with in-segment restenosis 7 months postimplantation. A 65-year-old male presenting with stable angina was treated for a 95% stenosis in the proximal left anterior descending artery. The lesion was predilated with a semicompliant balloon 2.5×12 mm and a scoring balloon 3.0×13 mm before implanting a 3.5×15 mm magnesium BRS (Magmaris; Biotronik AG, Bülach, Switzerland) carefully sized by OCT. The magnesium BRS was postdilated using a 3.75×8 mm noncompliant balloon. Final angiography and OCT showed good expansion and apposition of the scaffold without signs of fracture.The patient was prescribed ticagrelor 90 mg×2 for 1 year and lifelong clopidogrel 75 mg×1 because of an allergy to acetylsalicylic acid. At readmission because of recurrent angina, in-scaffold restenosis of the proximal left anterior descending artery was identified. OCT showed a 70% reduction in minimal scaffold area from 10.3 to 3.1 mm2 (Figure). The in-scaffold restenosis was treated by implantation of a metallic 3.5×23 mm everolimus-eluting stent (Xience; Abbott Vascular, Santa Clara, CA).Download figureDownload PowerPointFigure. Angiography and optical coherence tomography (OCT) images at baseline and at 7 months. A1, Baseline angiography with proximal left anterior descending artery stenosis (white arrow). A2, OCT after implantation of the magnesium BRS. Well expanded, no evident fractures. The proximal marker is marked by the green arrow. A3, Angiography showing acceptable final result. B1, Angiography 7 months after magnesium BRS implantation with in-scaffold restenosis (white arrow). B2, OCT frame at restenosis matched on frame level with the A2 image. Matching was performed by a dedicated software tool, QCU-CMS analysis software (Leiden University Medical Center, Leiden, the Netherlands), and based on consistent identifiable landmarks. Visible struts are marked with red arrows. The proximal scaffold marker is indicated by the green arrow. The scaffold area was reduced from 10.3 to 3.1 mm2. B3, OCT frame from the site of the distal marker (green arrow). No restenosis was seen, but struts are not readily identified at the 7-month time point.The magnesium BRS has a degradation time of around 12 months, but the major reduction in radial strength and scaffolding ability occurs from 3 months. Struts are not visible by angiography and are barely visible by OCT after 6 months because the reflective metallic appearance is reduced during the resorption process.1,2There was no indication of fracture in 3D reconstructions of the baseline OCT scan (Movie 1 in the Data Supplement, recording in survey mode slightly impairing 3D quality). Furthermore, the stenosis was not placed at a hinge point with excessive movement. The fast degradation time with loss of radial strength combined with a likely accelerated healing response at the dilated stenosis are possible causes for the restenosis.DisclosuresDr Barkholt received travel grant from St. Jude Medical and Biotronik. Dr Terkelsen received Institutional research grants from Terumo and Roche and speakers fee from Abiomed. Dr Christiansen received Institutional research grants from Biosensors, Biotronik, Abbott, Reva Medical, Boston Scientific, and Elixir and speaker fees from OrbusNeich, Boston Scientific, Terumo, and Abbott. Dr Holm received Institutional research grants from Biotronik, Abbott, Reva Medical, Boston Scientific, and Elixir and speaker fees from Terumo and Abbott.FootnotesThe Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl/doi:10.1161/CIRCINTERVENTIONS.117.005677/-/DC1.Correspondence to Trine Ørhøj Barkholt, MD, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark. E-mail [email protected]References1. Haude M, Ince H, Abizaid A, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Kaiser C, Eeckhout E, Lim ST, Escaned J, Garcia-Garcia HM, Waksman R. Safety and performance of the second-generation drug-eluting absorbable metal scaffold in patients with de-novo coronary artery lesions (BIOSOLVE-II): 6 month results of a prospective, multicentre, non-randomised, first-in-man trial.Lancet. 2016; 387:31–39. doi: 10.1016/S0140-6736(15)00447-X.CrossrefMedlineGoogle Scholar2. Fajadet J, Haude M, Joner M, Koolen J, Lee M, Tölg R, Waksman R. Magmaris preliminary recommendation upon commercial launch: a consensus from the expert panel on 14 April 2016.EuroIntervention. 2016; 12:828–833. doi: 10.4244/EIJV12I7A137.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Bossard M, Madanchi M, Avdijaj D, Attinger-Toller A, Cioffi G, Seiler T, Tersalvi G, Kobza R, Schüpfer G and Cuculi F (2022) Long-Term Outcomes After Implantation of Magnesium-Based Bioresorbable Scaffolds—Insights From an All-Comer Registry, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2022.856930, 9 Barkholt T, Neghabat O, Holck E, Andreasen L, Christiansen E and Holm N (2021) Bioresorbable magnesium scaffold in the treatment of simple coronary bifurcation lesions: The BIFSORB pilot II study, Catheterization and Cardiovascular Interventions, 10.1002/ccd.30051, 99:4, (1075-1083), Online publication date: 1-Mar-2022. 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Marynissen T, McCutcheon K and Bennett J (2018) Early collapse causing stenosis in a resorbable magnesium scaffold, Catheterization and Cardiovascular Interventions, 10.1002/ccd.27676, 92:2, (310-312), Online publication date: 1-Aug-2018. October 2017Vol 10, Issue 10 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.117.005677PMID: 29042399 Originally publishedOctober 17, 2017 Keywordspercutaneous coronary interventionoptical coherence tomographybiodegradableangiographyrestenosisPDF download Advertisement SubjectsOptical Coherence Tomography (OCT)Percutaneous Coronary InterventionRestenosis