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CASE20191101_015
| IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Imaging: Intravascular | |
| The Positive Remodeling After Bioresorbable Scaffolding That Mimics Dissection | |
| Wen-Pin Huang1, Wei Tsung Lai1 | |
| Cheng Hsin General Hospital, Taiwan1, | |
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[Clinical Information]
- Patient initials or identifier number:
MW
-Relevant clinical history and physical exam:
The 52-year-old male is a patient with CAD, s/p PCI at LAD-M in 2015, HTN, and dyslipidemia. He was admitted in Oct 2016 due to stable angina with positive TET noted at OPD. No remarkable finding was noted in physical examination.
-Relevant test results prior to catheterization:
The baseline EKG was sinus rhythm, but TET was positive for myocardial ischemia. CXR showed cardiomegaly, echocardiography revealed normal systolic function but LV hypertrophy.
- Relevant catheterization findings:
During hospitalization, CAG showed significant stenosis at LAD-P, LAD-D, and RCA-PL. PCI with BVS at LAD-P and POBA at LAD-D was done. RCA-PL lesion was left due to small caliber.
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[Interventional Management]
- Procedural step:
•2016/10: admitted for stable angina with TET (+)•no ISR at LAD-M•de novo lesion at LAD-P, LAD-D•POBA + BVS at LAD-P, POBA at LAD-D
•2016/12: admitted for stable angina with TET (+)•angiography: LAD-P inscaffold dissection with intimal flap•OCT: no dissection but positive remodeling with BVS malapposition•mimicking dissection!!•POBA at LAD-P •2017/10: admitted for stable angina with TET (+)•DES at RCA-M, PL •2018/08: admitted for stable angina with TET (+)•OCT checked, POBA + DEB at LAD-M, POBA + DES at LAD-D (dissection after POBA)  case.pptx- Case Summary:
The positive remodeling after BVS is not uncommon, but may not be recognized each time. In our case, it mimicked dissection with intimal flap, it may be mis-diagnosed if not disclosed by OCT, leading to different management, for example, one more stenting for dissection sealing, instead of further expansion by balloon dilatation.
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