J INVASIVE CARDIOL 2019;31(7):E226.
Key words: bioresorbable vascular scaffold, blunt chest trauma, coronary dissection, optical coherence tomography
A 53-year-old man suffered a high-impact car collision. An increase in troponin levels was detected after 8 hours, so the patient underwent coronary angiography, which demonstrated an annular lesion in the proximal left anterior descending (LAD) artery (Figure 1A). Optical coherence tomography (OCT) showed an intimomedial flap and a double-lumen from the proximal to the mid LAD without significant atherosclerosis (Figure 1B). A 3.5 x 15 mm Magmaris direct magnesium resorbable scaffold (Biotronik) was deployed under OCT guidance. Then, progression of the hematoma to the mid LAD was observed, which precluded balloon postdilation and forced the implantation of a 2.5 x 15 mm Orsiro drug-eluting stent (Biotronik) in the mid LAD, achieving good final angiographic and OCT results (Figures 1C and 1D). After 3 months, OCT showed incomplete endothelialization of the bioresorbable scaffold and malapposition of one strut at its proximal edge, possibly due to positive vessel remodeling (Figures 1E and 1F). Conservative management with prolonged dual-antiplatelet therapy was decided.
The treatment of coronary lesions caused by blunt chest trauma is controversial. As far as we know, this is the first report of a coronary dissection related to blunt chest trauma evaluated with OCT and treated with a magnesium resorbable scaffold. OCT verified that the dissection took place on a previously healthy artery. In addition, follow-up OCT allows the evaluation of vessel remodeling as well as the diagnosis of alterations in the scaffold, such as malapposition, which can determine changes in the patient’s treatment.
From the Cardiology Department. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. The authors report that patient consent was provided for publication of the images used herein.
Manuscript accepted November 30, 2018.
Address for correspondence: José Abellán-Huerta, MD, PhD, Calle Obispo Rafael Torija, s/n, 13005 Ciudad Real, Ciudad Real, Spain. Email: firstname.lastname@example.org