Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1148-1155
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1148
Successful bailout stenting strategy against rare spontaneous retrograde dissection of partially absorbed magnesium-based resorbable scaffold: A case report
Zhen-Yu Liao, Jer-Young Liou, Shen-Chang Lin, Huei-Fong Hung, Che-Ming Chang, Lung-Ching Chen, Su-Kiat Chua, Huey-Ming Lo, Chi-Feng Hung
Zhen-Yu Liao, Jer-Young Liou, Shen-Chang Lin, Huei-Fong Hung, Che-Ming Chang, Lung-Ching Chen, Su-Kiat Chua, Huey-Ming Lo, Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
Zhen-Yu Liao, Ph.D. Program in Nutrition and Food Science, Fu Jen Catholic University , New Taipei 24205, Taiwan
Huey-Ming Lo, Chi-Feng Hung, School of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
Chi-Feng Hung, MS Program Transdisciplinary Long-Term Care, Fu Jen Catholic University, New Taipei 24205, Taiwan
Chi-Feng Hung, Ph.D. Program in Pharmaceutical Biotechnology, Fu Jen Catholic University, New Taipei 24205, Taiwan
Author contributions: Liao ZY was the attending physician, reviewed the literature, and contributed to manuscript drafting; Liou JY, Lin SC, Hung HF, Chang CM, Chen LC, Chua SK and Lo HM reviewed the literature and contributed to manuscript drafting; Hung CF was responsible for revision of the manuscript for important intellectual content; all authors gave approval for final version of the manuscript to be submitted for publication.
Informed consent statement: Informed written consent for publication of this report and its accompanying images was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chi-Feng Hung, PhD, Professor, School of Medicine, Fu Jen Catholic University, No. 510 Zhongzheng Road, Xinzhuang District, New Taipei 24205, Taiwan. 054317@mail.fju.edu.tw
Received: October 18, 2020
Peer-review started: October 18, 2020
First decision: December 13, 2020
Revised: December 19, 2020
Accepted: January 5, 2021
Article in press: January 5, 2021
Published online: February 16, 2021
Abstract
BACKGROUND

In the development of coronary stent technology, bioresorbable scaffolds are promising milestones in improving the clinical treatment of coronary artery disease. The “leave nothing behind” motto is the premise of the fourth revolution in percutaneous coronary intervention (PCI). Studies proving the safety and efficacy of the magnesium-based resorbable scaffolds (MgBRSs) include the BIOSOLVE-I and BIOSOLVE-II trials and the latest BIOSOLVE-IV registry. However, spontaneous retrograde dissection of a partially absorbed MgBRS may still occur, albeit rarely.

CASE SUMMARY

We describe an unusual case of coronary artery disease in a patient who had undergone a successful PCI 8 mo earlier, where an MgBRS was implanted into the left anterior descending artery (LAD) and left circumflex artery with drug-coated balloons for a ramus intermedius branch stenosis to achieve the “leave nothing behind” therapeutic intention and was currently presenting with a gradual worsening of chest tightness. The distal edge vascular response, during subsequent attempts with balloon angioplasty was performed smoothly. However, spontaneous retrograde dissection of a partially absorbed MgBRS in the LAD ensued. Successful bailout stenting was performed with revascularization of the entry and exit sites created by spontaneous dissection and complete sealing of the intramural hematoma. The patient recovered well and was discharged after 2 d of intervention. When followed up in August 2020 (7 mo later), the patient showed uneventful recovery.

CONCLUSION

Spontaneous retrograde dissection of a partially absorbed MgBRS was successfully treated using bailout sirolimus-eluting coronary stent strategy.

Keywords: Coronary artery disease, Percutaneous coronary intervention, Magnesium, Stents, Dissection, Case report

Core Tip: Coronary revascularization with percutaneous coronary intervention primarily involves using balloon angioplasty and intracoronary stenting with either drug-eluting stents or bare metal stents. Other methods of improving coronary blood flow include atherectomy and radiation. Resorbable metallic scaffolds have been developed to reduce adverse events after permanent metallic stent placement, such as restenosis or stent thrombosis. These adverse events have been attributed to persistent inflammation, impaired vasomotion, ongoing tissue growth within the stent frame, and neoatherosclerosis. Spontaneous coronary artery dissection is rare. Reverse dissection of post-magnesium-based resorbable scaffold stenting is even rarer.