CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 October;178(10):846-8

DOI: 10.23736/S0393-3660.18.03946-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Myocardial temporary ischemia in bioresorbable scaffold implantation: a MIBI- scintigraphy and angiography case report

Lucia LELLI ¹ ✉, Andrea PICCHI ², Leonardo MISURACA ², Alberto MASSONI ², Paolo CALABRIA ³, Francesco D’UBALDO ², Ugo LIMBRUNO ²

¹ Unit of Nuclear Medicine, Misericordia Hospital, ASL Sud Est, Grosseto, Italy; ² Cardiovascular Interventional Unit, Misericordia Hospital, ASL Sud Est, Grosseto, Italy; ³ Unit of Cardiology, Misericordia Hospital, ASL Sud Est, Grosseto, Italy

Bioresorbable scaffold (BRS) is the latest development in the coronary stent technology. It provides temporary scaffolding disappearing thereafter, disengaging the treated vessel from its cage. BRS are completely resorbed in approximately three years. Often patients after implantation of BRS and despite successful implantation, continue to experience angina, whose etiology is unclear. A 60-year-old man presented to our emergency department with anterior chest pain while working. The transradial coronary angiogram showed the occlusion of the proximal segment of the left anterior descending artery (LAD); the culprit lesion was treated by implantation of a BRS. After BRS implantation patient continued to complain effort angina so a stress-test in therapy and then an Echostress was performed with negative result. Patient continued to experience angina and so a MIBI-SPECT was performed. The SPECT showed a moderate inducible ischemia on the mid septum that was ascribed to the occlusion of 2 septal branches jailed by the bulky structure of the BRS. A second MIBI-SPECT performed 7 month later showed a normal perfusion. Discussion: In our case report chest pain after an implantation of BRS occurs early and was likely due to ischemia induced by the bulky structure of the device. The normalization of perfusion and the amelioration of chest pain 11 months later was not due to the resorbed of BRS or to the possible formation of collateral circulation but was likely due to the acquired the malapposition of BRS struts.

KEY WORDS: Coronary disease; Perfusion imaging; Angina pectoris