Revascularization without des: a case report about metallic–less revascularization techniques

Abstract Rational 56 years old patient, admitted to our service for myocardial infarction without ST elevation. In medical history he had dyslipidaemia, hypertension and familiarity for cardiovascular disease, without previous cardiological problems. The patient went to the ER for chest pain, started after his work shift. When admitted to the ER, the patient was still symptomatic for chest pain, with resolution after 3 hours after somministration of analgesics, with normal pressure and heart rate. An ECG was performed, without relevant findings, at the blood exams significative movement of cardiac troponins. At the echocardiogram apical hypokinesia of left ventricle with preserved ejection fraction. Technical Resolution Coronarography was performed, with evidence of severe diffuse atheromatic disease of the left anterior descending artery (LAD) at the proximal segment and sub–occlusive stenosis at the middle segment. Due to the diffuseness of the atherosclerotic disease on the LAD, which would have required a complete stenting of the artery, which using classical Drug Eluted Stents would have led to a complete metallization of the artery, in such a young patient who does not have medical history suggesting a progression of the atheromatic disease, metallic–less techniques were chosen. The two lesions were pre–dilatated with a non–compliant (NC) balloon. The proximal lesion was treated with a bioresorbable scaffold (BVS) Magmaris 3x25 mm, post–dilatated with a NC balloon, without complications. The distal segment was treated with a Drug Eluting Balloon (DEB) Pantera Lux 2.5x20 mm, expanded for 90 seconds, with evidence of focal dissection, not flow limiting.At the clinical follow–up performed at one and three months, the patient was asymptomatic for angina, without any cardiovascular event. Clinical Implications When facing coronaropathy in a young patient, it is a good option to treat the coronary with techniques that do not leave metallic material in the arteries, which exposes young patients to a higher rate of complications if compared to older patients. When it is preferred to use this kind of techniques, the options can be DEB or BVS. As seen in this case report, often the DEB can lead to complications. It’s well–known that every DEB complication needs a DES to fix it. However, little is proven and studied about the use of BVS on de–novo lesions and on coronary injuries as complications of “conventional” PCI, as well as those derived from DEB delivery.