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We report the case of a 61-year-od male, hospitalized for unstable angina. Coronary angiography showed a severe lesion in the middle third of the left anterior descending coronary artery. Percutaneous coronary intervention was performed with stent implantation. Coronary rupture was observed with contrast spilling to the left ventricle (type IV coronary perforation) immediately after balloon post-dilatation. After partial heparin reversal with protamine and prolonged balloon inflation at low pressure, coronary rupture was controlled, with a good final angiographic result. Subsequent echocardiography showed minimal pericardial effusion. Post-procedure clinical follow-up was satisfactory.

IVUS serial evaluation of the novel DESolve BRS showed an increase in the device dimensions between baseline and 6 months, with concomitant enlargement of lumen dimensions and effective suppression of neointimal proliferation. At 18 months, no footprint of the scaffold was detected and the initial lumen enlargement was sustained.

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Background:The everolimus-eluting stent with durable polymer or biolimus A9-eluting stent with bioabsorbable polymer were designed to minimize local inflammatory response providing better endothelial coverage of the struts. The aim of this study was to report the intravascular ultrasound results at 6 months comparing these devices, a secondary endpoint of the BIOACTIVE study. Methods: The BIOACTIVE trial is a multicenter, randomized trial (1:1), whose primary endpoint was to compare coronary endothelial function and the percentage of strut coverage of the BioMatrix™ and Xience V™ stents using optical coherence tomography. Patients with single de novo lesions in native coronary arteries, between 3.0 and 3.5 mm, and maximum length of 20 mm were included. Diabetic patients or patients with ST segment elevation myocardial infarction, ostial lesions, bifurcation lesions or lesions with thrombus were excluded. Results: Intracoronary ultrasound was performed in 35 (87.5%) of 40 patients included in the study (BioMatrix™ = 21, and Xience V™ = 14). Vessel volume (339.8 ± 149.4 mm 3 vs. 343.0 ± 118.6 mm 3 ; p = 0.95), stent volume (174.9 ± 73.6 mm 3 vs. 166.2 ± 53.6 mm 3 ; p = 0.70), intimal hyperplasia volume (3.7 ± 2.6 mm 3 vs. 4.5 ± 5.9 mm 3 ; p = 0.57) and percent intimal hyperplasia volume (2.3 ± 2.0% vs. 2.4 ± 2.8%; p = 0.90) did not show statistically significant differences. Conclusions: In this randomized comparison, both stents proved to be effective in suppressing neointimal response in medium-term follow-up and did not show indirect signs of local toxicity.

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Evaluation of the Late Stent Recoil of First and Second Generation Drug-Eluting Stents Background: Radial expansion and vessel wall scaffolding properties of stainless steel stents have improved the outcomes of coronary balloon angioplasty. Thinner struts and new platform designs are characteristic of more contemporaneous stents, but it is not clear whether these changes may result in devices with less radial strength, susceptible to elastic recoil, especially in the very late follow-up. This study was aimed at assessing late stent recoil in two generations of drug-eluting stents (DES) using serial intravascular ultrasound (IVUS) analysis. Methods: Twenty-five patients with single de novo coronary lesions, treated with DES (12 Cypher TM and 13 BioMatrix TM), were included and serial IVUS analysis was performed after stent implantation and at 4-6-months and 4-5 years of follow-up. Stent volume index was compared between the procedure and the mid and long-term follow-ups. Stent recoil was defined as a decrease > 10% of the stent volume index. Results: Most of the patients were male (52%), with mean age of 58.8 + 7.6 years, and 28% were diabetic. Stent volume index, the primary objective of this study, was 7.7 + 1.5 mm³/mm post-procedure, 7.7 + 2.1 mm³/mm at 4-6 months and 7.8 + 1.6 mm³/mm at 4-5 years, with a delta of-0.02 + 1.6 mm³/mm (P = 0.97). The long-term delta stent volume index was 0.13 + 1.8 mm³/mm (1.7%) for the Cypher TM stent and-0.05 + 1.3 mm³/mm (-0.6%) for the BioMatrix TM stent (P = 0.78). Conclusions: Serial IVUS analysis showed that stainless steel DES of different generations did not show evidence of long-term elastic recoil.

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