A 55-year-old male with diabetes and previous coronary artery disease underwent coronary angiography (CAG) which showed 50% lesion in the left anterior descending artery and a tight stenosis with calcium in the D1 branch. Percutaneous coronary intervention (PCI) was performed on the D1 branch with balloon angioplasty followed by deployment of an Absorb bioresorbable vascular scaffold (BVS). Optical coherence tomography (OCT) showed under expansion of the distal part of the scaffold. High pressure balloon dilatation was then performed to achieve complete apposition, which OCT confirmed along with decreased subintimal staining. The message conveyed is that BVS require proper preparation for calcific lesions, high pressure ballooning

1. Clinical History:
55 Yrs Male.
DM
Previous CAG 2009, Class II Angina
TMT Positive for inducible ischaemia
Normal LV Function by 2D Echo

2. CAG
● CAG at Right
Radial Approach
● LAD after D1
50% lesion,
Proximal
Calcium.
● D1 - Medina :
0,0,1 , Tight
Stenoses with
Calcium.

3. Strategy:
 Deploy Absorb -
BVS after POBA to
D1

4. PCI
Hardware:
• Rt Radial approach
-6F Teurmo sheath,
Guiding: EBU 3.5-6F,
• Guide wire:
-BMW – to D1.
• QCA: D1 80% stenosis,
Diameter: 2.5mm,
length: 15mm.

5. PCI
POBA done with 2.5x10 NC at 10 atm Sub-intimal staining at the lesion and
branch site

6. PCI
•BVS –
Absorb 2.5 x 18mm.

7. Scaffold deployed
● Absorb – BVS
deployed at
nominal press. of
7 atm – 30sec with
incremental
pressure of 2 atm
at 5 sec interval.

8. PCI
● OCT checked calcium with fibro- OCT did show under expansion at distal
fatty plaque is present at the site of part of lesion and sub intimal collection
lesion and distal .

9. PCI
● High Pressure dilatation
with 2.5x10 and 2.75x15 NC
Balloons at 12 atm done for
complete apposition of
Scaffold.

10. PCI
● OCT showed better
apposition and sub intimal
staining decreasing.
● Side branch well
protected.

11. PCI
• LAO Cranial
View provided a
better impression
of stent
apposition,

12. Message
 BVS Absorb needs proper bed preparation with
NC Balloon for calcific lesions.
 High Pressure Dilatation with sub Intimal
Collection can lead to vessel damage and
perforation.
 OCT guidance is obligatory for Absorb BVS.

13. THANK YOU