PMC4802336_01
Prior carotid angioplasty for in-stent restenosis. Panel A highlights the baseline angiography with evidence of significant in-stent restenosis after implantation of a 7.0 x 40 mm carotid stent. Panel B shows the deployment of a 7.0 mm Angioguard Rx filter and predilation with a Trek 3.0 x 20 mm balloon. Panel C highlights the result after predilation. Panel D shows the dilation with a 5.0 x 80 mm Legflow drug-eluting balloon. Panels E and F highlight the satisfactory final angiographic result, in both lateral (E) and antero-posterior (F) views.
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After diagnostic angiography with a 6 French JR4 diagnostic catheter (VistaBrite, Cordis, Miami, FL, USA) highlighting diffuse in-stent restenosis involving both the common and internal carotid artery, a 7 French JR4 guiding catheter was placed in the proximal right common carotid artery via a 0.035'' 260 cm Amplatz Super Stiff J-Tip Emerald guidewire (Cordis) (Fig. 1).
Bioresorbable vascular scaffold implantation. Panel A highlights the baseline angiography disclosing severe in-stent restenosis, with the minimum lumen diameter localized in the internal carotid artery. Panel B shows the result after deployment of a 7.0 mm Angioguard Rx filter and predilation with a 4.0 x 40 mm Ryujin Plus balloon. Panel C highlights the implantation of the 3.5 x 28 mm absorb bioresorbable vascular scaffold. Panel D shows the angioscopic image after balloon retrieval, with arrows pinpointing the bioresorbable vascular scaffold radiopaque markers. Panel E highlights the postdilation with an 4.5 x 30 mm Aviator Plus balloon. Panel F shows the satisfactory final angiographic result.
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As previously, after diagnostic angiography confirming the recurrent in-stent restenosis, we deployed a 7 French JR4 guiding catheter and a 7.0 Angioguard Rx filter (Fig. 2).
Duplex ultrasound scan performed 13 months after bioresorbable vascular scaffold implantation, disclosing a patent stent in the common and internal carotid artery. Panel A highlights the color B mode image, highlighting the presence of both metallic stent and bioresorbable vascular scaffold contours. Panel B shows the pulsed wave Doppler measurements in the distal internal carotid artery, confirming the absence of significant in-stent restenosis. BVS = bioresorbable vascular scaffold; ICA = internal carotid artery.
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The patient remained asymptomatic after discharge, and control duplex ultrasound scan was performed 6 and 13 months later (Fig. 3), without any evidence of restenosis. Specifically, after more than 12 months since the implantation of the bioresorbable vascular scaffold for recurrent in-stent restenosis and drug-eluting balloon failure, the metallic stent appeared largely patent, with faint signs of still incompletely resorbed scaffold struts, all devoid of significant restenosis (peak systolic velocity 120 cm/s, end-diastolic velocity 40 cm/s) (Fig. 3).